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Journal of the Korean Academy of Child and Adolescent Psychiatry
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Korean Academy of Child and Adolescent Psychiatry
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Volume 12, Issue 2 - Dec 2001
Volume 12, Issue 1 - Jun 2001
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WATER AND INTROSPECTION
Shin, Sung-Woong ; Cho, Soo-Churl ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 3~24
All human being can't exist by oneself. That is, all human being depend on intimate attachment for their survival. Physical and psychological powers and control functions are prerequisites for one's survival and these serve important functions in interpersonal relationships. There are two kinds of powers and controls. One is positive power which helps one survive effectively. Another one is negative power which disturbs one's effective survival. Introspection is one of the positive power and most important process in understanding oneself and others. Thus, the purpose of this study is to elucidate the physical and psychological meaning of the characteristics of water and based on this meaning, to suggest one way of introspection. The authors reviewed the precept of water which is described in Bible and oriental classical books such as 'the Analects of Confuicus(論語)', 'Tao Te Ching(道德經)', 'Mencius(맹자)', 'Chronicle(史記)', 'The Doctrine of the Mean(中庸)', 'University(大學)'. The author also reviewed 'The History of Three Countries(삼국사기, 삼국유사)', 'The Precept of Religion', and 'the modern poems' which includes the symbolic meaning of water. The results are summarized as follows：1) The flow of water itself is the expression of introspection. Because, water does not flow without filling a puddle. 2) Water is the symbol of 'Immortality'. 3) Water symbolizes 'Modesty and Trust'. 4) Water is the symbol of 'Freedom from Greed'. 5) Water symbolizes 'Goodness and Beauty'. 6) Water symbolizes 'Naturality and Love'. Immortality, Modesty and Trust, Freedom from Greed, Goodness and Beauty, and Naturality and Love are eternal, universal values which all human should seek and achieve. By the process of introspection through the symbolic meaning of water, we can achieve these positive aspects of human mind and spirit.
A COMPARATIVE STUDY UPON EVENT-RELATED POTENTIALS OF THE PATIENTS WITH ADHD AND NORMAL CHILDREN USING FOURIER TRANSFORMATION AND WAVELET ANALYSIS
Park, Jin-Hyoung ; Kim, Hee-Chan ; Cho, Soo-Churl ; Shin, Sung-Woong ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 25~50
Using Fourier transformation and wavelet analysis, we compared the auditory event-related potentials of the patients with attention deficit-hyperactivity disorders(abbr. ADHD, 13 boys) and normal control children(8 boys). Amplitudes of the event-related potentials which were calculated via Fourier transformation were compared between the groups and between conditions(non-target versus target) in each group. To the non-target stimuli, the patients with ADHD showed significantly greater amplitudes across almost all of the electrode sites and frequencies. To the target stimuli, the incidents which ADHD patients showed much higher amplitudes than normal controls significantly decreased, while those of the reverse results increased significantly. These results were consistent with the comparison results about negative difference wave(abbr. Nd wave) using Fourier transformation. In summary, it was proved that non-target stimulus which should be ignored elicited more robust electrical response from the patients with ADHD than normal children, but the target stimulus which reguired active processing did much less electrical activity in the patients. For the patients, they showed much inhibited electrical response to the target stimuli in some electrodes and frequency ranges. Normal children were more strongly stimulated by the target stimuli in almost all electrodes and frequency ranges than the patients, but less in prefrontal leads and frontal leads. Wavelet analysis results proved that early responses(0-300msec) to the nontarget stimuli of the patients were significantly greater than the normal controls in prefrontal, anterior frontal, some parts of temporal, and occipital lobes and that late response(300-370msec) were significantly lesser than normal children in parietal and central electrodes. Target stimuli elicited significantly higher electrical activity in both group than non-target stimuli did. Prefrontal and frontal lobes showed stronger responses in the patients than normal children irrespective of stimulus condition, but parietal and temporal lobes did higher activities in normal children than the patients only to the target stimuli. In conclusion, the patients with ADHD showed much greater responses to the stimuli which should be ignored, but failed to activated the necessary processes to the target stimuli. Also, we found that the frequency-dimension analysis and wavelet analysis were useful for the signal processing such as event related potentials.
COMPARATIVE STUDY UPON THE CHARACTERISTICS OF WRITING BETWEEN THE PATIENTS WITH WRITING DISABILITIES AND NORMAL ELEMENTARY SCHOOL STUDENTS
Cho, Soo-Churl ; Shin, Sung-Woong ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 51~70
Characteristics of handwriting were investigated and compared between the patients with writing disabilities and normal elementary school pupils. Generally, the heights of the letters of the patients were significantly larger than those of normal children, and letters of the patients were more sparsely distributed than those of controls. The distance between the words were significantly reduced in the patients’ writings, which indicated that patients had much more problems of space-leaving than normal pupils. Letter heights differences were significant across all grades in the patients and normal controls. The heights of the letters decreased as they grew older, and the slope of the decrements were more steeper in normal girls(r=-0.45) than girls with writing disabilities(r=-0.16). Sex differences were found in the letter spacings in low grades(grades 1, 2), that is, the distances between the letters were significantly narrower in the male patients than normal boys in these grades, and the differences were almost indiscriminating in grades 3 through 5, and finally, in sixth grade, letter spacings were signifycantly broader in normal boys than male dysgraphics. In girls, letter spacings were significantly broader in the patients across all grades. These findings supports the hypothesis that male and female writings were qualitatively different and that distinct mechanisms served in boys and girls dysgraphics. Across all grades and sexes, spaces between the words of the patients were significantly broader than normal pupils, which suggested that space-leaving between the words was important in Korean writings. There was trend that letter spacings and word spacings decreased across grades, but in girls, no correlations between the letter spacings and grades were found. Correlation analyses revealed that letter heights and letter spacings had mild correlation(r=0.11-0.15), and that letter spacings and word spacings had robust correlation(r=0.99). Phonological errors were mostly found in last phoneme(Jong-seong), especially double-phoneme(ㄳ, ㄵ, ㄶ, ㄺ, ㄻ, ㄼ, ㄾ, ㄿ, ㅀ, ㅄ), and in the case the sound values changed due to assimilations of phonemes. Semantic errors were rare in both groups. Space-leaving errors were correlated with phonological errors, and more frequent in boys than girls. In conclusion, significant differences existed in the letter heights, letter spacings, word spacings, and frequencies of phonological errors and spaceleaving errors between the patients with writing disabilities and normal pupils. The characteristics of writings changed across grades and the developmental profiles were somewhat quantitatively different between the groups. The differences became obvious from the second-third grades.
PSYCHIATRIC CHARACTERISTICS OF CHILD PATIENTS WITH INVERSION OF CHROMOSOME 9 - A PRELIMINARY STUDY -
Lee, Jun-Young ; Hwang, Jun-Won ; Hong, Kang-E ; Kim, Jae-Won ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 71~78
Objectives：Few studies have examined the psychiatric properties or child developmental problems associated with inversion of chromosome 9. The purpose of this study is to examine the psychiatric properties of child patients who have inversion of chromosome 9, focused on behavioral problems and child developmental problems like motor or language developmental delay, intellectual impairment, and growth retardation. Methods：1) The authors examined the cases referred for cytogenetic examination from 1984 to 2000 at Seoul National University Hospital in Korea. The cases with the examination result of inversion of chromosome 9 were collected and informations about the departments which referred and the main reasons for referral were also checked. 2) 12 child subjects with inversion of chromosome 9 and their parents underwent psychiatric interview and parent questionnaire(child and adolescent past history questionnare, CBCL). 45 normal students whose sex and age were matched to patients were selected as a control group. Results：1) There were 165 cases of inversion of chromosome 9. The major departments which referred were Obstetrics and Gynecology(47.3%), Pediatrics(23.6%) and Child and Adolescent Psychiatry(17.0%). The major reasons for referral from the Pediatrics and the Child and Adolescent Psychiatry department (67 cases total) were intellectual impairment(35.8%), language or motor developmental delay(31.3%), suspected Fragile X syndrome(23.9%), and growth retardation(20.9%). 2) Compared to normal control group, the rate to be included in the clinical range with regard to the social problems profile was higher in patient group according to the CBCL results. The patient group had language and motor developmental delay. Conclusion：There is a possibility of inversion of chromosome 9 to be associated with child developmental problems or behavioral problems. This study is the first approach to evaluate the developmental aspects associated with inversion of chromosome 9.
THE SOCIAL SKILLS TRAINING IN CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER(ADHD)
Han, Eun-Sun ; Lee, Yang-Hee ; Ahn, Dong-Hyun ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 79~93
Objectives：The children with ADHD have some deficits in social skills including the peer relationship. There are several approaches to teaching social skills to children with ADHD, and many are combined in comprehensive programs to maximize treatment effects. We conducted this study to explore the direct effects of social skills training program applied to children with ADHD. Method：Five children and their mothers who were diagnosed to Attention Deficit-Hyperactivity Disorder(ADHD) in Y elementary school survey participated to the study. We performed the 8-session program with the modified the Pfiffner and McBurnett's program(1997), and assessed the social skills, problem behaviors, peer acceptance, parenting behaviors, and parenting stress. Results：Parent's reports were some different from teacher's reports；teacher reported improvement in social skills and peer acceptance, but parent notified decrement in problem behaviors. And also, there were no changes in maternal behaviors, but significant reducing effects in parenting stress. Conclusion：The stimulants are mainstream in treatment of children with ADHD. The social skills training programs are combined in comprehensive treatment programs in children with ADHD to maximize treatment effects.
A STUDY ON THE PERSONALITY TRAIT OF BULLYING & VICTIMIZED SCHOOL CHILDRENS
Jhin, Hea-Kyung ; Kim, Jong-Won ; Choi, Yun-Jung ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 94~102
Bullying has recently become a serious social problem in Korean society. Bullying, which is defined as a phenomenon that one particular student is intensively and continuously harassed or ostracized by a group of students, is apt to produce harmful effects on bullies as well as victims. Bullying has many causes including those originated from the personality of victims and bullies. This study is designed to investigate the difference in personality trait between victims, bullies, victims/bullies, and neither. The subjects of this study were 215(115 male and 100 female) 6th-grade students in the primary school in Seoul. Questionnares were distributed to the students and their carers. The student carers were also asked to answer the questions for a survey called the Korean Personality Invertory for Children(KPI-C). SPSS was used for the statistical analysis of the collected test information；ANOVA, post hoc scheffe test, and T-test were used to analyze the differences between the tested groups. The result of the study is as follows. 1) The victims, bullies, victims/bullies and neither totaled respectively 11(5.1%), 56(26.0%), 11(5.1%) and 137(63.7%). 115 were male and 100 were female. 2) The frequency of victimized is as follows：1 time is 15(7.0%), 2 times is 4(1.9%) and more than 3 times is 3(1.4%). The frequency of bullying is as follows；1 time is 40(18.6%), 2 times is 17 (7.9%) and more than 3 times is 10(4.7%). 3) The differences between froups in KPI-C test is as follows. (1) The ESR(p=.00) scale was significantly lower in the victims group than in the neither group and the HPR(p=.00) scale and PSY(p<.01) scale were significantly higher in the former than in the latter. (2) The ESR(p=.00) scale was significantly lower in the victims/bullies group than in the neither group and the SOM(p=.00) scale and HPR(p=.00) scale were significantly higher in the formaer than in the latter. (3) The SOC(p=.00) scale, PSY(p<.01) scale and AUT(p=.00) scale were significantly higher in the victims group than in the bullies group. (4) There is statistically no difference between the bullies group and the neither group. To conclusion, Victims need to learn how to cope with harsh situations, or they will have to face difficulties in relationships. Even after they experience bullying, they may not realize why they have been bullied, or speak out for themselves.
CLINICAL CHARACTERISTICS OF CHRONIC MOTOR TIC DISORDER AND TOURETTE'S DISORDER
Shin, Sung-Woong ; Lim, Myung-Ho ; Hyun, Tae-Young ; Seong, Yang-Sook ; Cho, Soo-Churl ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 103~114
Tourette's disorder is a disease which manifests one or more motor tics and vocal tics for more than a year. Chronic motor tic or vocal tic disorders are characterized by only one kind of tics for more than a year. We intended to investigate the clinical characteristics of the patients with chronic motor tic disorders or Tourette's disorders who had admitted from May 1, 1998 to May 1, 1999 to Seoul National University Hospital Child and Adolescent Psychiatry ward. In addition, we compared the clinical characteristics of the patients in order to elucidate the relationship between the two disorders. The patients with learning disabilities were selected as controls. There was no statistically significant difference between the onsets of the patients with chronic motor tic disorders(n=13,
years), and Tourette's disorder(n=39,
years), but with learning disability(
years). Also, the patients with chronic motor tic disorder and Tourette's disorder showed similar age at admission(
years), duration of admission(
weeks), mothers' ages at child birth(
years old),and fathers' age at child birth(
years old). We observed that those who had learning disabilities were alike in those aspects, except for age at visit to clinic(
years old). Family history of psychiatric illnesses(24.1% versus 46.2%), recognized precipitating factors(11.1% versus 35.7%) and response to pharmacological treatments(77.8% versus 76.9%) of the patients with chronic motor tic disorders and Tourette's disorders were observed and no differences were found. Comorbid patterns of diseases were noted. Intrafamilial conflicts were more common in the patients with learning disabilities than those with chronic tic disorders or Tourette's disorders. Precipitating factors were observed more frequent in chronic tic disorder and Tourette's disorder than learning disability. Neurocognitive profiles were investigated, and verbal IQs of the patients with chronic motor tic disorder, Tourette's disorder and learning disability were
, performance IQs
and full-scale IQs
, respectively, which were found to be not significantly different. No difference was found in structural neurological abnormalities and EEG profiles. The patients with learning disabilities showed more common Bender-Gestalt test abnormalities. In conclusion, we have not found any affirmative clues for the division of chronic motor tic disorder and Tourette's disorder in clinical perspective.
THE CLINICAL FEATURES OF THREE SUB-DIAGNOSED GROUPS OF TIC DISORDERS AND FACTORS RELATED WITH ILLNESS SEVERITY
Jung, Hee-Yeon ; Hwang, Jeong-Min ; Chung, Sun-Ju ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 115~124
Objective：The purpose of this study was to compare the clinical features of children with three subdiagnoses of tic disorder(transient tic disorder(TTD), chronic tic disorder(CTD) and Tourette’s disorder (TD)) and to exam the factors related with illness severity of them. Method：Subjects were 69 children who met DSM-IV criteria for tic disorder and 43 control children. All subjects were investigated demographic and clinical factors related to tic. The severity of tic was assessed with the Yale Global Tic Severity Scale(YGTSS) in tic disorder children. The Child Behavior Checklist(CBCL) was accomplished by parents of all subjects. Results：Children with TTD had not only shorter duration of tic symtoms but also milder tic severity and impairment than those with CTD and TD. They also had significantly lower scores on most CBCL subscales than children with CTD and TD, while they were similar with controls in all the CBCL subcale scores except aggressive behavior. Children with CTD and those with TD were similar to each other in clinical variables except number of tic symptom and scores on CBCL social problem subscale. The interference and intensity of motor tic symptoms and duration of tic symptoms were significant predictors of global impairment score on YGTSS, while the presence of comorbid ADHD was a preictor of the total behavior problem score of CBCL. Conclusion：These findings indicate that duration of tic symptoms and the presence of comorbid ADHD as well as the severity of tic symptoms strongly associated with the illness severity of children with tic disorder. These results also suggest that those clinical factors may be more important for assessing the severity of illness and determining the treatment strategy than the sub-diagnosis itself in children with tic disorder.
SURVEY OF SELF-CONCEPT AND DEPRESSION-ANXIETY OF THE ELEMENTARY SCHOOL BOYS WITH LEARNING DISABILITIES
Kim, Bong-Soo ; Seong, Deock-Kyu ; Jung, Yeong ; Yoo, Hee-Jung ; Cho, Soo-Churl ; Shin, Sung-Woong ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 125~137
We investigated the self-concept, subjective depression, and state-trait anxiety of the school boys with learning disabilities(abbr. LD, n=86) and compared them with normal boys(n=52) using Piers-Harris Self-Concept Inventory, Child Depression Inventory(abbr. CDI), and State-Trait Anxiety Inventory(abbr. STAI). With regard to Piers-Harris Self-Concept Inventory total scores, there was no significant difference between two groups, but normal boys showed higher scores in intellectual and school status, physical appearance, and happiness-satisfaction subscales than patients with LD. The male patients with LD showed significantly higher ratings in CDI total scores, and CDI subscales - ineffectiveness, anhedonia, negative self-esteem than normal children. The patients with LD reported significantly higher state anxiety, but not trait anxiety. Correlation analyses revealed that self-concept decreased over time, and depression-anxiety increased across grades in the patients with LD, but not in normal children. Especially, negative mood, anhedonia, negative self-esteem subscales of CDI, and state-trait anxiety showed significant positive correlation with grades. In both groups, CDI scores were inversely correlated with Piers-Harris Self-Concept and positively with State-Trait anxiety. In conclusion, self-concept problems which were related with school achievement and self-esteem were more abundant in the patients with LD than normal children, self-image problem, depression and anxiety increased across grades. According to regression analysis, age, behavior subscale, intellectual-school status, anxiety, popularity, happiness-satisfaction, CDI-ineffectiveness, interpersonal problem, negative self-esteem, and state anxiety could explain the self-concept in the patients with LD, not in normal children. So, the self-concept of the patients with LD were found to be related to the school achievement and stress when comparing with peers. In conclusion, elementary school boys with LD showed lower self-concept, higher depression and anxiety, and these differences increased across grades. Since the patients with LD have concomitant depression and anxiety disorders, it is important that comorbidity with emotional problems should be explored and managed properly.
A RESEARCH ON RISK FACTORS OF ADOLESCENT SEXUAL BEHAVIORS
Park, In-Seon ; Baek, Yeon-Ok ; Han, In-Young ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 138~148
The focus of the research was on identifying the risk factors that may result in unprepared intercourse among the adolescent from an ecological systems prospective. A survey questionnaire was conducted from September through December 1999 to 2326 youths, ages from 13-18 years old. After eliminating thirty respondents from Unwed Mother's Home we found that 8.8% of the remaining respondents had experienced sexual intercourse. Of those, 5% of the female and 13.4% of male adolescents has had sexual intercourse, showing 2.7 times more for the male sample population. Broken down to age groups, 3.2% of the thirteen years old group and 19.2% of the eighteen years old group had experienced intercourse, an almost six fold increase in the older age group. To find out the differences between those who had and not had experienced intercourse the group was then divided into two comparative groups by same sex and age variables. Findings from comparative analysis identified five ecological system risk factors among the youth sample that had intercourse；First, individual factor：adolescents who thought less of themselves or didn't consider their potentials, those more exposed other risk behaviors such as drinking, smoking, drugs, runaway and come in contact with pornography, those who thought they knew more about sex and etc. Second, family factor：those who thought family was less important, had less supportive family, higher or lower income family and etc. Third, peer factor：Both groups thought friends were important and had their support. The group with intercourse experience seems to be think that more peers are experiencing other risk behavior. Fourth, school factor：Those in the group who had experienced intercourse seems to think school is less important and with lower academic achievements. Fifth, community factor：There were no statistical significant differences found between the two groups. The overall results from this study implies that if we want to prevent our youths from having unprepared intercourse during adolescence the significance of having meaningful emerging self, family relationship and school experience is important. This study identified the risk factors leading to adolescent sexual intercourse but further research is necessary in finding out about their predictability.
A CASE OF PANDAS WITH CHILDHOOD DISINTEGRATIVE DISORDER
Cho, Soo-Churl ; Seong, Deock-Kyu ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 12, issue 1, 2001, Pages 149~156
After the fact that obsessive-compulsive symptoms or tic symptoms are common in Sydenham's chorea which is a sequale of rheumatic fever produced by group A beta-hemolytic streptococcus was reported, the association between group A beta-hemolytic streptococcus and a subgroup of obsessivecompulsive disorder(OCD) or tic disorder has been attentioned. This subgroup shared a unique clinical course, characterized by an abrupt onset of symptoms and/or dramatic exacerbations. And this subgroup was distinguished by pre-pubertal onset of symptoms, neurological abnormalities(choreiform movements and a unique pattern of motoric hyperactivity), as well as by relapsing and remitting symptom course. Acronym PANDAS(pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) was used to denote a subgroup of OCD or tic disorder patients with these clinical characteristics. Then, there was a report suggesting that PANDAS category include some of attention-deficit/hyperactivity disorder(ADHD) and were two case reports of anorexia nervosa and body dysmorphic disorder with characteristics of PANDAS. This case is a patient who developed normally until age of 7, but after pharyngeal inflammation with high fever, he showed disturbance of cognition, social relationship, and language and communication, as well as tic symtoms and abnormal movement on face, hand, and foot. We report this case with review of literatures, because we think that this case belongs to the PANDAS category. Based on this observation, we suggest that PANDAS category include some of childhood disintegrative disorder as well as OCD, tic disorder, and ADHD.