Journal of the Korean Academy of Child and Adolescent Psychiatry最新文献

Objectives: The brain and autonomic nervous system are tightly interconnected and may be involved in various psychiatric conditions. We explored whether electroencephalographic (EEG) coherence and vagally mediated heart rate variability (vmHRV) differ between male children with autism spectrum disorder (ASD) and typically developing (TD) children, and how these measures are associated with the clinical characteristics of ASD.

Methods: We recorded resting-state EEG and vmHRV in 14 male children with ASD and 14 TD children. The Social Responsiveness Scale (SRS) was used to assess the clinical characteristics of the ASD group.

Results: vmHRV measures (root mean square of successive RR intervals [RMSSD], percentage of successive RR intervals that differ by more than 50 ms [pNN50], and high-frequnecy power) did not differ between the ASD and TD groups. By contrast, the beta1 coherence between the T5 and T6 electrodes (beta1 coherence [T5-T6]) was lower in the ASD group than in the TD group, even after correction for multiple comparisons. This coherence measure demonstrated a positive correlation with RMSSD and a negative correlation with the SRS social motivation subscale score (SRS-Motivation). Moreover, pNN50 acted as a moderator of the association between beta1 coherence (T5-T6) and SRS-Motivation.

Conclusion: Resting-state EEG coherence may be associated with the clinical characteristics of ASD, and vmHRV may exert a moderating effect on this relationship. These preliminary findings suggest that the concurrent evaluation of brain and autonomic functions can be useful for elucidating the pathophysiology of ASD.

Grief in children and adolescents is a complex and often misunderstood process, distinct from adult mourning in both its expression and developmental impact. Young people may struggle to articulate their emotions, leading to behavioral changes that are frequently misinterpreted or overlooked in clinical practice. This review explores how grief manifests across developmental stages, highlighting age-specific responses, common clinical presentations, and factors that influence resilience or vulnerability. Drawing on current evidence and clinical insight, we examine assessment strategies and therapeutic approaches tailored to the needs of grieving children and adolescents. Case illustrations are used to provide context and deepen understanding. By emphasizing a developmentally sensitive, emotionally attuned, and culturally aware perspective, this article aims to equip clinicians with practical tools to better support children and adolescents coping with loss.

Emotion dysregulation is a transdiagnostic risk factor in childhood psychopathology that contributes to externalizing behaviors. To address this, regulation-focused psychotherapy for children (RFP-C) has been developed as a manualized, short-term psychodynamic intervention for 5- to 12-year-olds with externalizing behaviors rooted in underlying emotion dysregulation and affective conflict. The therapy follows a structured protocol comprising 16 child play therapy sessions and 4 parent sessions. Therapists use symbolic play, identify defense-based play disruptions, and adopt affect labeling to enhance implicit emotion regulation. In parent sessions, the "triangle of conflict" was deployed to reframe behavior as defensive, strengthen reflective functioning, and scaffold regulatory growth. Pilot data (n=3) and a randomized controlled trial (n=43) demonstrated feasibility, high adherence, and statistically significant reductions in oppositional defiant symptoms, with maintenance at the three- and six-month follow-ups. The limitations included a small sample size, reliance on waitlist controls, and scarce long-term durability data. Future research is needed to conduct multisite trials with active comparators, assess applicability across diverse conditions, and examine changes in defense mechanisms. To implement RFP-C across broader clinical settings, it is crucial to train specialized clinicians, identify children who are well suited for RFP-C, and integrate appropriate interventions tailored to each child's unique challenges.

Disruptive behavior disorder (DBD), which includes oppositional defiant disorder and conduct disorder, is among the most common externalizing disorders in childhood and adolescence. This review aimed to identify evidence-based psychotherapies for DBD and summarize their empirical foundations and characteristics. We searched for randomized controlled trials and systematic reviews using PubMed, PsycINFO, and Google Scholar, focusing on major evidence-based guidelines from the National Institute for Health and Care Excellence (NICE), American Psychological Association (APA), and Agency for Healthcare Research and Quality (AHRQ). Six interventions demonstrated the strongest empirical support: Incredible Years, Triple P, Parent-Child Interaction Therapy, Parent Management Training-Oregon Model, Multisystemic Therapy, and Treatment Foster Care-Oregon Model. These programs share a behavioral foundation that emphasizes parent-centered interventions as the core therapeutic mechanism. Considering treatment resistance and legal implications, multisystemic and community-based approaches are recommended for adolescents with severe antisocial behavior. In Korea, existing studies have primarily applied cognitive-behavioral, child-focused, and group interventions with limited fidelity assessments and few parent-focused trials. Future priorities include disseminating and validating parent-based behavioral therapies, establishing long-term follow-up systems, and adapting digital or telehealth platforms to enhance accessibility. Strengthening evidence-based, scalable behavioral interventions is crucial for improving the outcomes of Korean youths with DBD.

Objectives: Autism spectrum disorder (ASD) is a major neurodevelopmental disorder characterized by persistent deficits in social communication along with restricted, repetitive patterns of behaviour and interests. FMR1 gene, which causes Fragile X syndrome (FXS), is the most common single-gene contributor to ASD. Variations in CGG repeat length within the 5' untranslated region of FMR1 are central to the etiology of FXS. Given the established connection between FXS and ASD, this study investigated whether the trinucleotide repeat region of FMR1 is associated with ASD in Bangladeshi children.

Methods: Seventy-one children participated in the study, including 39 with ASD and 32 age-matched controls. The FMR1 region was amplified using polymerase chain reaction and subsequently sequenced.

Results: There was no statistically significant difference in the number of CGG repeats between patients with ASD and controls (p>0.01), with the most common repeat number being 27 in both groups. Interspersion of the two AGG trinucleotides among the CGG repeats was the most common pattern found in the study participants, with frequencies of 56.67% and 50.00% in the ASD and the control groups, respectively.

Conclusion: This study provides preliminary evidence that CGG repeat expansion in the FMR1 gene is unlikely to represent a major genetic contributor to ASD in Bangladeshi children. However, given the limited sample size, further investigations with a larger cohort are required to confirm these findings.

Objectives: PEERS^® for Preschoolers (P4P) is an evidence-based, parent-assisted social skills program for young autistic children and children with other social challenges. The program aims to promote age-appropriate social skills and improve peer relationships. Parent employment status and cultural background may influence families' engagement in the program and their relationship with providers, which can affect use of P4P skills outside weekly sessions. This study examined whether these parent demographic characteristics predicted program response in P4P.

Methods: Participants were 46 autistic children (mean age=4.50 years; 78.3% male) and their caregivers who completed P4P between 2015 and 2019. Families took part in a 16-week curriculum with parallel child and parent groups. Program outcomes were measured using parent-report instruments, including the Social Responsiveness Scale-Second Edition, Social Skills Improvement System subscales of Social Skills and Problem Behaviors, Quality of Play Questionnaire, and Parenting Stress Index, Fourth Edition, Short-Form.

Results: Significant improvements were found in child social responsiveness, social skills, behavior problems, number of playdates, and parenting stress from pre- to post-P4P. Parent employment status and race/ethnicity did not significantly predict any program outcomes.

Conclusion: Results indicate that P4P benefits families broadly, with no observed effect of parent employment status or race/ethnicity on outcomes. Future research should replicate these findings in a larger, more diverse sample and examine additional potential predictors of program response to inform clinical decision-making.

Objectives: Adolescent non-suicidal self-injury (NSSI) is a marker of severe emotional distress and a significant public health concern. This narrative review aimed to synthesize major theoretical models explaining the psychopathology of NSSI and critically evaluate the efficacy of evidence-based psychotherapies using the most recent high-level evidence.

Methods: We searched articles in major academic databases published from January 2000 up to June 2025. We prioritized studies on adolescents, including efficacy studies (randomized controlled trials and meta-analyses) addressing NSSI as a primary outcome, and key theoretical papers.

Results: NSSI was understood through integrated models, prominently featuring emotion dysregulation (biosocial theory), experiential avoidance (cognitive-behavioral models), impaired mentalization (attachment theory), and operant conditioning (functional model). The synthesis of high-level evidence, including a 2021 review from Cochrane, indicated that dialectical behavior therapy (DBT) had the strongest empirical support (high-certainty evidence) for reducing adolescent NSSI. However, while mentalization-based treatment, acceptance and commitment therapy, and attachment-based family therapy offered promising mechanism-specific approaches, evidence for their effectiveness for NSSI was preliminary or uncertain.

Conclusion: DBT is currently the first-line treatment for NSSIs in adolescents. However, the field must move toward personalized care. Future research should focus on validating alternative therapies through head-to-head randomized controlled trials, identifying the core change mechanisms across treatments, and implementing stepwise care models to improve accessibility.

Bullying among children and adolescents is a complex and widespread problem with profound psychological, social, and legal implications. It includes physical, verbal, relational, sexual, and cyber forms involving perpetrators, victims, and bully-victims. This narrative literature review synthesizes findings from studies published between 2000 and 2024 across disciplines including psychology, education, public health, and law. Data were sourced from PubMed, Scopus, and Google Scholar, focusing on global and Indonesian contexts. Bullying arises from a combination of individual traits (e.g., impulsivity and poor emotional regulation), family dynamics (e.g., insecure attachment and low cohesion), and school and cultural influences. Theoretical frameworks such as the social learning and attachment theories help explain how bullying behaviors are learned and reinforced. Neurobiologically, bullying acts as a chronic stressor that dysregulates the hypothalamic-pituitary-adrenal axis, thereby increasing the vulnerability to anxiety, depression, and behavioral disorders. Legally, many countries, including Indonesia, have implemented child protection laws that emphasize restorative justice. Interventions such as Mindfulness-Based Cognitive Therapy for Children, Cognitive-Behavioral Play Therapy, and school-based programs such as KiVa and Olweus have effectively reduced bullying and promoted psychosocial well-being. Addressing bullying requires a comprehensive multilevel approach that integrates psychological, educational, familial, and legal strategies. Sustainable and culturally relevant interventions supported by collaboration among schools, families, and policymakers are crucial for fostering safe and supportive environments for children and adolescents.