Korean Child Behavior Checklist Research Articles

Mobile App-Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial.

In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members. We aimed to develop and evaluate the feasibility of a mobile app-assisted parent training program for reducing problem behaviors in children with ASD. This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app-assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app-assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior. Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48%) participants and the control group included 22 (52%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of -0.5 (95% CI -4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of -2.1 (95% CI -8.5 to 2.5). However, there was no significant difference in Clinical Global Impression-Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference -2, 95% CI -4 to 1). Caregivers' stress evaluated using the Korean Parenting Stress Index Fourth Edition-Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation. The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices' accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD. CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?&seq=23112.

Effects of Forest Activities on Sleep and Problematic Behaviors in Young Children

Background and objective: This study aims to determine the effects of forest activities, such as forest meditation and forest experience, on young children's sleep and problematic behaviors and to compare the changes that occur according to the type of forest activity.Methods: Fifty-nine five-year-old children from early childhood education institutions in Cheongju City, Korea, participated. The experiment took place over five weeks between May 3 and 31, 2022. Activities were conducted twice a week for a total of eight sessions. The forest meditation and forest experience groups carried out activities in the forest. The control group carried out thematic activities according to the Nuri curriculum followed by early childhood education institutions. The Korean version of the Children's Sleep Habits Questionnaire was used to assess the participants' sleep duration and sleep habits, and the Korean Child Behavior Checklist for Ages 1.5-5 was used to assess problematic behaviors.Results: We found a statistically significant increase in the average sleep duration of the children in the meditation group, as well as a statistically significant decrease in their total sleep habits score and the scores of the bedtime resistance, sleep onset delay, and sleep anxiety subdomains of sleep habits. A statistically significant decrease was observed in the forest experience group's scores for total problematic behaviors and internalizing problems. We also found a statistically significant positive correlation between sleep habits and problematic behaviors.Conclusion: These findings demonstrate that static activities, such as forest meditation activities, increase sleep duration and improve sleep habits, while dynamic activities, such as forest experience activities, improve problematic behaviors and internalizing problems. Providing specific programs that appropriately utilize static and dynamic forest activities can help improve sleep and problematic behaviors in young children.

Impact of the COVID-19 Pandemic on Behavioral and Emotional Factors in Pediatric Patients with Headache

Purpose: Headaches are common in childhood and adolescence and are often exacerbated by various triggers. The coronavirus disease 2019 (COVID-19) pandemic has profoundly altered daily life worldwide. In this study, we investigated potential behavioral and emotional changes among pediatric patients with headaches, treated either before or after the onset of the COVID-19 pandemic. Methods: We examined 162 patients who visited our pediatric headache clinic between March 2018 and August 2021. The study included patients with primary headaches who completed a questionnaire assessing behavioral and psychiatric characteristics. We reviewed their clinical features, imaging studies, and scores on the Korean Child Behavior Checklist (K-CBCL), State Anxiety Inventory for Children (SAIC), Trait Anxiety Inventory for Children, and Children’s Depression Inventory (CDI). Statistical analysis was conducted using the Mann-Whitney U test, among other methods. Results: The 162 patients (mean age, 11.7±3.3 years) were classified based on whether they visited before (n=81) or after (n=81) the onset of the COVID-19 pandemic. The average CDI and SAIC scores were significantly higher in those who presented after pandemic onset. In this group, the odds ratio for an abnormal CDI score was 4.971. A weak positive correlation was found between the CDI score and the K-CBCL total problem score, with a correlation coefficient of 0.297. Conclusion: Pediatric patients visiting the headache clinic after the onset of the COVID-19 pandemic exhibited significantly higher levels of anxiety and depression compared to pre-pandemic visitors. Recognizing the considerable impact of the pandemic may help inform the management of pediatric headaches.

Psychological aftereffects experienced by sexually abused children: Psychopathological characteristics revealed by the K-CBCL.

Children who have been sexually abused may experience various short- and long-term psychological sequelae and behavioral problems. This study assessed the mental health of sexually abused children using the Korean-Child Behavior Checklist (K-CBCL) and examined differences from a control group. The participants were 97 children who had been sexually abused and who visited a local Sunflower Center, and 178 control participants. Data were collected via the K-CBCL and analyzed using SPSS version 25.0. T-tests, cross-tabulation, and logistic regression analyses were performed. Scores from the K-CBCL Problem Behavior Syndrome scale were compared between sexually abused children and the control participants. Significant differences were observed between the 2 groups in all the subscales. Compared to the control group, children who were sexually abused showed statistically significant differences in the total problem behavior, internalization, anxiety/depression, withdrawal/depression (withdrawn), somatic symptoms, externalization, rule-breaking behavior (delinquency), aggressive behavior, social immaturity, thought problems, attention problems, and other subscale scores. Sexual violence hurts the overall mental health of children who are abused, including their emotional, behavioral, and social factors. Our findings suggest that multidisciplinary assessment and treatment are required for children who have experienced sexual abuse.

Adjuvant Therapy for Attention in Children with ADHD Using Game-Type Digital Therapy.

Children diagnosed with attention deficit hyperactivity disorder (ADHD) require early intervention and sustained treatment. This study used a game-based digital treatment planning NeuroWorld DTx to analyze the impact on attention and cognitive function in children with ADHD. Thirty children diagnosed with ADHD were recruited and subjected to a four-week NeuroWorld DTx digital treatment. To assess the impact of the digital therapeutic therapy on children's attention, we used the comprehension attention test (CAT) and Korean ADHD Rating Scale (K-ARS). Clinical global impression (CGI) and the Korean-child behavior checklist (K-CBCL 6-18) were used to examine the degree of improvement in ADHD. After four weeks, significant differences in the sensitivity and response style indices were noted, as compared with the baseline in the CAT test; in the case of K-ARS and CGI, a moderate decrease in ADHD was confirmed. The study achieved better results for the "total behavior problems" belonging to the K-CBCL assessment. Game-based digital therapy intervention can be a treatment method that elicits interest and satisfaction in children with ADHD and can be used as an adjunct to drug therapy to improve the quality of life and strengthen attention in children with symptoms of ADHD.

Factors Affecting Depressive Symptoms in Children and Adolescents With Epilepsy.

ObjectivesWe aimed to evaluate the clinical and psychological factors influencing depressive symptoms in children and adolescents with epilepsy.MethodsWe administered self-reported questionnaires assessing children’s depressive symptoms (Children’s Depression Inventory, CDI) and anxiety (Revised Children’s Manifest Anxiety Scale, RCMAS) to children and adolescents with epilepsy (n=87, age range=6–17 years). We asked their parents to complete questionnaires on epilepsy-related variables, parental stress (Questionnaire on Resources and Stress, QRS), parental anxiety (State-Trait Anxiety Inventory, STAI), family functioning (Family Adaptability and Cohesion Evaluation Scale, FACES), children’s attention problems (Abbreviated Conners Parent Rating Scale Revised, CPRS), and children’s behavioral problems (Korean Child Behavior Checklist, K-CBCL). Stepwise multiple regression analysis was performed to identify predictive variables affecting depressive symptoms.ResultsFamily adaptability (r=-0.240, p=0.026), family cohesion (r=-0.381, p<0.001), children’s attention problems (r=0.290, p=0.006), children’s anxiety (r=0.714, p<0.001), children’s behavioral problems (r=0.371, p<0.001), parental anxiety (r=0.320, p=0.003), and parental stress (r=0.335, p=0.002) were significantly correlated with children’s depressive symptoms. Children’s anxiety (β=0.655, p<0.001) and parental stress (β=0.198, p=0.013) were significantly related to their depressive symptoms (adjusted R2=0.539).ConclusionClinicians should detect and manage children’s anxiety and parental stress, which may affect depressive symptoms in children and adolescents with epilepsy.

Preliminary Validation Study of the Korean Version of the DSM-5 Level 2 Cross-Cutting Symptom Measure: Depression and Irritability for Parents of Children Aged 6-17 Years.

ObjectivesThis study investigated the reliability and validity of the Korean version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 2 Cross-Cutting Symptom Measure—Patient-Reported Outcomes Measurement Information System (PROMIS)–Depression and the Irritability for parents of children aged 6–17 years.MethodsParticipants were 190 children diagnosed with depressive disorder (n=14), anxiety disorder (n=21), attention-deficit/hyperactivity disorder (ADHD; n=111), ADHD with anxious depression (n=13), and tic disorder with somatic symptoms (n=31). Patients were 8–15 years of age. The participants’ mothers completed the Korean versions of the DSM-5 Level 2 Cross-Cutting Symptom Measure— PROMIS Depression and Irritability (Affective Reactivity Index, ARI), and the Korean Child Behavior Checklist (K-CBCL). Using these data, we calculated the reliability coefficient and examined the concurrent and discriminant validity of the PROMIS Depression and the Irritability (ARI) scales for assessing depression and irritability in children.ResultsThe reliability coefficient of the PROMIS Depression scale (Cronbach’s α) was 0.93. The correlation coefficient with the KCBCL DSM emotional problem score was 0.71. The PROMIS Depression scale significantly discriminated children with depressive disorders from those with other conditions. The reliability coefficient of the Irritability (ARI) scale was 0.91, suggesting its high reliability.ConclusionOur results suggest that the Korean version of the DSM-5 Level 2 Cross-Cutting Symptom Measure for Depression and Irritability Scales for parents of children aged 6–17 years is reliable and valid and may be an efficient alternative to the K-CBCL.

발달지연 아동의 고유수용성 감각 기반 치료 활동이 감각처리 및 문제행동에 미치는 효과: 사례 연구

The purpose of this study was to investigate the effect of proprioceptive sensory-based therapeutic activities on sensory processing and problematic behavior in children with developmental delay.&#x0D; The participants of this study were two 5-year-old children diagnosed with developmental delay that was mediated through proprioceptive sensory-based therapeutic activities. The mediation done once a week for 50 minutes per session, for a total of 12 sessions. To examine the effects of proprioceptive sensory-based treatment activities, sensory processing was evaluated using the Sensory Profile and problematic behaviors were evaluated using the Korean Child Behavior Checklist before and after the intervention. Data analysis was performed by calculating the difference in values before and after the intervention, and visual analysis was done using graphs.&#x0D; After the proprioceptive sensory-based treatment activity, participant 1 was clear in the following items: sensory profile, sensory processing, visual processing, vestibular sensory processing, tactile processing, multisensory processing, oral sensory processing, endurance and muscle tone control, body posture movement control, and activity level control. The difference improved from that of the doubt difference, and the results showed improvement in atrophy, depression and anxiety, social immaturity, attention problems, aggression, internalization problems, and externalization problems in the child and adolescent behavior evaluation scale. Participant 2 showed an improvement in all items except the reaction threshold items in the sensory profile, and atrophy, depression/anxiety, social immaturity, thinking problems, attention problems, delinquency, aggression, internalization problems, and externalization in the child and adolescent behavior evaluation scale. Improved results were found on the problem scale.&#x0D; This study confirmed that proprioceptive sensory-based therapeutic activity had a positive effect on sensory processing and problematic behavior in children with developmental delay.

Behavioral Changes in Preschool- and School-Age Korean Children: A Network Analysis.

The relationships between symptoms that comprise behavioral problems in children can be traced longitudinally to provide long-term support. This study identified signs that should be considered important in school age children by tracking changes in the relationships between different symptoms of behavioral problems in preschool and school age children. This study used Gaussian graphical network analysis to clarify the interaction of the overall subscales constituting the K-CBCL (Korean Child Behavior Checklist) and centrality in the network. In the Panel Study on Korean Children (PSKC), the K-CBCL/1.5–5 was used for children up to age six (first grade, elementary school), and the K-CBCL/6–18 was used for older children. In this study, 1323 PSKC samples (boys, n = 671; girls, n = 652) were used to distinguish nonclinical and (sub)clinical groups (T-score ≥ 60) compared to node centrality in each group’s CBCL subscale networks. Depression/anxiety was a persistent core symptom of the behavioral problem network in 5- and 7-year-old children. A new core symptom in 7-year-old children was posttraumatic stress problems added in version CBCL/6-18. Based on these results, it is necessary to consider both anxiety/depression and posttraumatic stress problems in preschool children to support the adaptation of school-age children.

The Impact of Maternal Adverse Childhood Experiences on Offspring's Internalizing and Externalizing Problems.

ObjectiveAdverse childhood experiences (ACEs) are associated with negative physical and mental health outcomes across the lifespan, but research on intergenerational transmission of maternal ACEs and its impact on the offspring’s mental health problems are limited. The study examines the effects of maternal ACEs on the risk of internalizing or externalizing problems among offspring. MethodsThere were 450 mother-child dyads. Mothers completed the Adverse Childhood Experiences Questionnaire. The child outcomes included internalizing and externalizing problems assessed by the Korean Child Behavior Checklist (K-CBCL) and Korean Youth Self-Report (K-YSR), depression assessed by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) and anxiety assessed by the Screen for Child Anxiety Related Emotional Disorders (SCARED). Results36.1% of mothers experienced at least one ACE, and 11.1% experienced three or more ACEs. Cumulative maternal ACEs were associated with internalizing problems, externalizing problems, depression and anxiety in the offspring. Household dysfunction from maternal ACEs was significantly associated with delinquent behavior, anxiety/depression, and somatic complaints in the offspring. ConclusionThe findings support the hypothesis that maternal ACEs are related to mental health problems in the offspring. Further research is needed to determine the factors mediating intergenerational transmission as well as intervention strategies to prevent ACEs and mental health problems in the offspring.

Problem Behaviors of Children from Multicultural and Mono-cultural Families in Korea: Differences in Behavior Evaluations between Parents and Teachers

In recent years, multicultural families are increasing in Korea. In such multicultural families, there may be language and interpersonal difficulties that affect the children. Given the possibility of real problems affecting academics and the potential for bias, the perceptions of parents and teachers is of vital importance. In this study, parents' and teachers’evaluations of problem behaviors of 405 elementary school students were collected on the Korean Child Behavior Checklist and the Korean Teacher's Report Form. Studies have shown that parents in multicultural families tend to rate their children's problems more seriously than in mono cultural families in the areas of Withdrawal/Depressed, Attention Problems, and Rule-Breaking Behaviors.Teachers rated boys from multicultural families as more problematic with Withdrawal/Depressed, Attention Problems, Rule-Breaking Behaviors, and overall scores than boys from monocultural families. Parents tended to take their child's problematic behaviors more seriously than teachers.In general, younger students were found to be more vulnerable to behavioral problems. This may indicate that an intervention is needed to help the children acculturate.

Rasch Analysis of the Korean-Child Behavior Checklist (K-CBCL) to Assess Emotional and Behavioral Problems in Children With Autism Spectrum Disorder

This study examined the validity of the Korean version of the Child Behavior Checklist (K-CBCL) with 180 children with autism spectrum disorder (ASD) in South Korea. Rasch analysis was applied to examine item fit, item difficulty, suitability of the response scale, and person and item separation indices of the K-CBCL. The results indicated that, with the exception of six out of the 119 items, the K-CBCL had a good item fit. Suitability of the rating scale was supported. Both Attention Problems and Aggressive Behavior factors differentiated two strata of behavior problems of children with ASD, whereas six other factors only captured one stratum of behavior problems. The item separation index indicated that the items were distributed well with high reliability. We demonstrated that statistical item analysis with the Rasch model could provide valuable information related to psychometric properties.

Cognitive and Behavioral Outcomes of School-aged Children Born Extremely Preterm: a Korean Single-center Study with Long-term Follow-up

BackgroundSchool-aged children born very preterm have been suggested to have worse cognitive and behavioral outcomes than children born full-term. Executive function (EF) is a higher level of cognitive function related to academic achievement. The present study aimed to evaluate the cognitive (including EF) and behavioral outcomes of Korean children born extremely preterm (EP) and to analyze any biological or socioeconomic risk factors for poor cognitive outcomes in this population.MethodsA total of 71 infants weighing < 1,000 g at birth or born before 30 weeks of gestation (EP group) who were admitted to the neonatal intensive care unit from 2008 to 2009 were included in this study and compared with 40 term-birth controls. The Korean Wechsler Intelligence Scale for Children-Fourth Edition, Advanced Test of Attention (ATA), Stroop test, Children's Color Trails Test (CCTT), and Wisconsin Card Sorting Test (WCST) were used. Additionally, the Korean Child Behavior Checklist (K-CBCL) and Korean ADHD Rating Scale (K-ARS) were completed. Perinatal and demographic data were collected and analyzed.ResultsThe mean full-scale intelligence quotient (FSIQ) score in the EP group was significantly lower than that of the term control group (89.1 ± 18.3 vs. 107.1 ± 12.7; P < 0.001). In the EP group, 26 (37%) children had an FSIQ score below 85, compared to only one child (3%) in the control group. Furthermore, the EP group showed significantly worse EF test results (ATA, Stroop test, CCTT, WCST). Except for the higher social immaturity subscore in the EP group, the K-CBCL and K-ARS scores were not different between the two groups. EP children who received laser treatment for retinopathy of prematurity (ROP) had an 8.8-fold increased risk of a low FSIQ score, and a 1-point increase in the discharge weight Z-score decreased the risk of a low FSIQ score by approximately half in this EP cohort.ConclusionThis is the first Korean study to investigate the cognitive and behavioral outcomes of school-aged children born EP. In the study cohort, EP children exhibited significantly lower FSIQ scores and EF than their full-term peers, and 37% of them had cognitive problems. Nonetheless, except for social immaturity, the behavioral problems were not different in EP children. Severe ROP and low discharge weight Z-score were identified as independent risk factors for low FSIQ score after adjusting for birth weight.

The Moderating Effect of Working Memory on the Relationship between Inattention and Aggressive Behavior in Attention-Deficit/Hyperactivity Disorder.

ObjectivesAlthough aggressive behavior in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) has previously shown correlations with hyperactivity/impulsivity, few studies have examined its association with inattention or the effect of working memory on aggressive behavior. This study aimed to assess the relationship between inattention and aggressive behavior and the effect of working memory on the relationship between inattention and aggressive behavior in children and adolescents with ADHD.MethodsThirty-one children and 26 adolescents with ADHD were retrospectively investigated. The subjects completed the Korean Wechsler Intelligence Scale for Children-Fourth Edition (KWISC-IV), the Korean Child Behavior Checklist (K-CBCL), and the Korean Children’s Depression Inventory (CDI).ResultsInattention was positively correlated with aggressive behavior in children and adolescents with ADHD and working memory showed an insignificant correlation. However, working memory had a significant moderating effect on aggressive behavior by interacting with inattention. The moderating effect of working memory manifested when the working memory index score on the K-WISC-IV was 73.5 points or higher, and it had a significant effect on aggressive behavior.ConclusionThis study shows that the severity of inattention and hyperactivity/impulsivity should be addressed to provide appropriate treatment to children and adolescents with ADHD who exhibit aggressive behavior.

Age-Related Changes in Auditory Nogo-N200 Latency in Medication-Naïve Children and Adolescents with Attention-Deficit/Hyperactivity Disorder.

Objective Event-related potential (ERP) changes with brain development in healthy children and adolescents. However, few studies have focused on age-related changes in the N200 and P300 components among individuals with attention-deficit/hyperactivity disorder (ADHD). Therefore, this study aimed to assess age-related differences in the auditory nogo-N200 components in individuals with ADHD. Methods We enrolled 46 participants with auditory nogo-N200 and nogo-P300 components. We assessed ADHD symptoms using the Advanced Test of Attention (ATA) and Korean ADHD Rating Scale-IV (K-ARS-IV). Moreover, we assessed emotional and behavioral problems using the Korean Child Behavior Checklist (K-CBCL). Further, we measured auditory ERPs. Results There were no differences with respect to sex or ATA, K-ARS-IV, and K-CBCL scores between the groups. With a 1-year increase in age, the nogo-N200 latency at Fz and Cz decreased by 6.08 ms and 4.88 ms, respectively; this result was statistically significant in multivariable linear regression adjusted by sex and dominant hand. Conclusion Our findings revealed age-related changes in nogo-N200 latency at the Fz and Cz electrodes in individuals with ADHD. Future studies should perform comparisons with healthy controls to determine whether auditory nogo-N200 can be used to evaluate the developmental level in individuals with ADHD.

Development of an After-School Day Treatment Program for Children with Severe Emotional/Behavioral Disturbances.

This article introduces Aizone, an after-school day treatment program for children with emotional/behavioral disturbances, and examines its effectiveness. Aizone targets children whose problems require intensive care, but are not severe enough to warrant hospitalization, and prioritizes those from low-income families. Based on the bio-psycho-social model, this program provides a variety of therapeutic interventions for both children and their parents, including individual and group therapy integrated under the concept of milieu therapy, as well as community linkage services. This study uses a prospective comparative method to examine the effectiveness of Aizone by comparing and validating the treatment outcomes of seven Aizone programs across Seoul. The Korean Child Behavior Checklist was administered by caregivers before and after intervention and the data was used in a repeated measures analysis. The effectiveness of the program in terms of reduction in emotional, behavioral symptoms, as well as the implications of the results are discussed.

A Validation Study of the Korean Child Behavior Checklist 1.5-5 in the Diagnosis of Autism Spectrum Disorder and Non-Autism Spectrum Disorder.

Objectives:The purpose of this study was to analyze the discriminant validity and the clinical cut off scores of the Child Behavior Checklist 1.5-5 (CBCL 1.5-5) in the diagnosis of autism spectrum disorder (ASD) and non-ASD.Methods:In total, 104 ASD and 441 non-ASD infants were included in the study. T-test, discriminant analysis, receiver operating characteristic (ROC) curve analysis, and odds ratio analysis were performed on the data.Results:The discriminant validity was confirmed by mean differences and discriminant analysis on the subscales of Emotionally reactive, Somatic complaints, Withdrawn, Sleep problems, Attention problems, Aggressive behavior, Internalizing problems, Externalizing problems, and Total problems, along with the Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scales between the two groups. ROC analysis showed that the following subscales significantly separated ASD from normal infants: Emotionally reactive, Somatic complaints, Withdrawn, Sleep problems, Attention problems, Aggressive behavior, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems. Moreover, the clinical cut off score criteria adopted in the Korean-CBCL 1.5-5 were shown to be valid for the subscales Withdrawn, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems.Conclusion:The subscales of Withdrawn, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems significantly discriminated infants with ASD.

The Relationship between Preschoolers’ Attachment Representation and Behavior Problems

Objective The main purpose of this study is to investigate the differences in preschoolers’ problem behaviors according to their types of attachment. Methods The subjects of this study were 100 children (42 boys and 58 girls) who were 4-6 years old and were attending childcare center or kindergarten in Jeonbuk J city. The attachment representation of the young children was assessed using the Attachment Story Completion Task (ASCT), which was developed by Bretherton, Ridgeway and Cassidy(1990). Preschoolers’ problem behaviors were assessed using the K-CBCL 1.5-5 (Korean Child Behavior Checklist for Ages 1-5-5). Content analysis and type classification were conducted based on various attachment coding manuals. The data were analyzed using Pearson’s correlation analysis and t/F test. Results and Conclusion First, in the secure attachment type, nurturance/empathy, companionship, calm response to separation, and positive affection response codes were high, whereas in the avoidant attachment type, high avoidance response appeared, and in the disorganized attachment type, high bizarre negative event codes and disjointed event codes were found. Second, atypical event scores were positively correlated with aggressive behavior, the externalization of behavior problems, and oppositional defiant behavior problem. Third, it was found that the subscales (aggression and oppositional defiant behavior problem) of the problem behaviors differ according to the attachment type of the preschoolers. In partivular, the insecure-disorganized attachment type showed significantly higher problem behavior scores than did the other attachment types (secure and, avoidant attachment types). This result supports the theory of a relationship between secure attachment and the social-emotional development of preschoolers, and highlights the need for attention to and involvement with preschoolers of the insecure-disorganized attachment type. Keywords: attachment representation based on narrative method, preschoolers’ problem behavior

Gender difference in the effects of lead exposure at different time windows on neurobehavioral development in 5-year-old children

BackgroundAlthough the association between lead exposure and children's neurodevelopment has been studied, gender differences remain to be investigated. We examined the effects of lead exposure on the neurobehavioral development of 5-year-old children to identify the vulnerable time window of exposure and potential gender difference. MethodA total of 1751 pregnant women and children participated in the prospective birth cohort study, Mothers and Children's Environmental Health study, since 2006. Lead levels were measured in the maternal blood in early and late pregnancies, in cord blood at birth, and in 2-, 3-, and 5-year-old children's blood. The behavior of 575 children aged 5years were assessed using the Korean Child Behavior Checklist. The association between the blood lead level at each time window and behavior was examined using a generalized linear model adjusted for potential confounders and covariates. ResultsLead levels at late pregnancy were significantly associated with increased risk of behavioral problems in males. Lead levels in 2- and 5-year-old children's blood significantly increased behavioral risks in females: for a 1-μg/dL increase in blood lead levels, the score for total behavioral problems increased by 3.00 (95% confidence interval [CI]: 0.56–5.45) during the late pregnancy in males, whereas it increased by 3.82 (95% CI: 1.25–6.39) at 2years and by 5.72 (95% CI: 0.44–10.99) at 5years in females with a stronger effect in attention and sleep problems. ConclusionEffects of lead toxicity on children's neurobehavioral development showed gender differences. Males were more susceptible to prenatal exposure, while females were more susceptible to postnatal exposure with stronger effects in attention and sleep problems.

Validity and reliability of the Korean version of Autism spectrum disorders-comorbid for children (ASD-CC)

The purpose of the present study was to develop and evaluate the psychometric properties of the Autism Spectrum Disorder-Comorbid for Children (ASD-CC). Mothers of children with ASD (n=330) and of typically developing children (n=220) aged from 2 to 16 years were asked to complete the ASD-CC. The next four steps were conducted for data analysis. First, the confirmatory factor analysis (CFA) was used to figure out the factor structure of the Korean version of the ASD-CC. It revealed that the 7-factor structure of the ASD-CC is applicable to the Korean version, likewise. Second, the internal consistency and test-retest reliability were measured, which showed to be in either moderately good or within the acceptable range. Third, the inter-correlations between the ASD-CC and the Korean Child Behavior Checklist (K-CBCL) and the ASD-CC and Korean Behavior Problem Inventory (BPI-01) were computed to be revealed as significant. In addition, the discriminant validity between ASD and typically developing children was well established. And finally, cut-off scores for 7 subscales of the ASD-CC were calculated using the Mean and Standard Deviation. These findings suggest that the Korean version of ASD-CC is a psychometrically sound instrument. Clinical and research implications as well as limitations are measured.