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

Objectives: This study examined whether self-control and perceived social support mediated the relationship between problematic Internet use (PIU) and depression in Korean adolescents and whether these pathways differed by PIU risk level based on the Korean version of the Young Internet Addiction Test (YIAT; cutoff=40).

Methods: This study analyzed data from 2294 adolescents in a nationally representative cohort. The participants completed the YIAT, Children's Depression Inventory, Gottfredson Self-Control Scale, and Social Support Appraisal Scale. A hierarchical regression based on Baron and Kenny's mediation framework was conducted, and serial multiple mediation was tested with subgroup analyses by risk level.

Results: PIU was significantly associated with lower self-control, lower perceived social support, and higher levels of depressive symptoms. Mediation analyses in the total sample revealed that self-control and social support partially mediated the association between PIU and depressive symptoms. The strongest indirect effect was found in the serial pathway (PIU → self-control → social support → depression; effect=0.050, 95% confidence interval, CI [0.037, 0.065]). Subgroup analyses demonstrated that self-control fully mediated this relationship in the low-risk group, whereas only partial mediation was observed in the high-risk group. In the low-risk group, the self-control-only pathway (PIU → self-control → depression) was the strongest (effect=0.071, 95% CI [0.049, 0.094]), whereas in the high-risk group, the serial path had the largest effect (effect=0.040, 95% CI [0.030, 0.051]).

Conclusion: Self-control and social support mediated the relationship between PIU and depressive symptoms, with different patterns by risk group. Therefore, targeted interventions should consider these distinct mechanisms.

Objectives: This study aimed to systematically review and meta-analyze the reliability of the International Trauma Questionnaire (ITQ) and its child/adolescent version (ITQ-CA) in diverse populations, including clinical and non-clinical groups.

Methods: A systematic search of the Scopus, Web of Science, and PubMed databases was conducted using predefined inclusion criteria. Studies reporting Cronbach's α values for ITQ or ITQ-CA total scores or subscales (post-traumatic stress disorder [PTSD] and disturbances in self-organization [DSO], respectively) were included. Quality was assessed using the National Institutes of Health Quality Assessment Tool. A reliability generalization meta-analysis was conducted using a random-effects model to evaluate internal consistency. Heterogeneity was assessed using Cochran's Q and I² statistics, and publication bias was examined using Egger's test and funnel plots.

Results: Sixty-two studies with 37766 participants from 28 countries were included. The ITQ-18 demonstrated high reliability, with a total score Cronbach's α of 0.896 (k=33; 95% confidence interval [0.8773-0.9129]), PTSD subscale α=0.852 (k=45), and DSO subscale α=0.869 (k=45). The ITQ-CA showed strong internal consistency with a total score α of 0.887 (k=7) and subscale α values of 0.819 for PTSD (k=9) and 0.900 for DSO (k=9). Although the ITQ-22 was analyzed in fewer studies (k=4), it demonstrated promising reliability. High heterogeneity (I²>80%) was observed, but no significant publication bias was detected.

Conclusion: The ITQ and ITQ-CA are reliable tools for assessing PTSD and complex PTSD in diverse populations. The findings underscore their psychometric robustness, but the marked heterogeneity highlights the need for contextual adaptations. Future research should expand on longitudinal studies and assess underrepresented regions to enhance cross-cultural validity.

Objectives: Attention-deficit/hyperactivity disorder (ADHD) significantly affects mental health in all age groups; however, its diagnosis remains challenging. This study evaluated the diagnostic accuracy of the Comprehensive Attention Test (CAT), a computerized tool designed to assess various aspects of attention in children with ADHD, in order to provide the groundwork for clinically applicable interpretation guidelines.

Methods: Factor analysis was performed on the scores of seven CAT subtests (visual and auditory selective attention tasks, sustained attention task, flanker task, divided attention task, and spatial working memory tasks) collected from 5214 subjects aged 4-49 years diagnosed with ADHD at 15 psychiatric clinics in South Korea. Their scores were compared with those of 500 participants with no attention problems.

Results: CAT subtests were grouped into either three or four factors depending on the age group. Omission error, commission error, and response time variability formed either one or two factors that effectively distinguished ADHD from non-ADHD with high sensitivity and specificity (4-5 years old: areas under the receiver operating characteristic curve [AUROCs] 0.937 and 0.779; 6-8 years old: AUROCs 0.841 and 0.878; 9-18 years old: AUROC 0.864; 19-49 years old: AUROC 0.792). The mean response time and working memory test results formed separate factors. While mean response time was a poor diagnostic indicator of ADHD, it revealed significant differences when psychiatric comorbidities were present.

Conclusion: CAT results can be categorized into factors reflecting inattentiveness, disinhibition, and working memory. These factors may help diagnose ADHD or detect psychiatric comorbidities.

Objectives: Despite the increasing prevalence of anorexia nervosa (AN) in Asia, standardized treatments are lacking in South Korea. This study examined the feasibility and effectiveness of evidence-based psychological treatments for AN in Korean children and adolescents.

Methods: This retrospective study included outpatients diagnosed with AN, aged <18 years, who received either family-based treatment (FBT; n=102) or specialist supportive clinical management (SSCM; n=43). Feasibility was measured using dropout rates, and effectiveness was assessed using outcome variables, including changes in body mass index (BMI) and eating disorder (ED) pathology, using an intention-to-treat approach.

Results: The mean dropout rate was 41%, and the mean BMI increase was 2.76 kg/m². Overall, there were no differences between the treatment groups in terms of the dropout rate or outcomes, except for the frequency of starvation. SSCM group exhibited greater reductions in starvation frequency (F(1,139)=4.80, p=0.030, η_p ²=0.034) with a small effect size. Lower BMI and higher ED psychopathology at baseline were associated with a greater BMI increase at the end of treatment.

Conclusion: These results suggest that both FBT and SSCM are feasible and effective for Korean children and adolescents with AN. Notably, SSCM may be more effective in individuals who frequently starved. Further controlled trials are needed to examine the effectiveness and improve treatment retention by incorporating cultural considerations.

Objectives: This study aimed to estimate the prevalence of Internet addiction (IA) among Korean adolescents and examine its association with psychiatric comorbidities and mental health symptoms.

Methods: A total of 270 adolescents and their parents participated in this study. Parents completed the Internet Addiction Proneness Scale for Youth: Observer Version and the Diagnostic Predictive Scales, whereas adolescents completed the Center for Epidemiological Studies Depression Scale for Children, the Screen for Child Anxiety-Related Disorders, and the Youth Self-Report. Group differences in psychiatric disorders and mental health symptoms across IA levels were analyzed.

Results: Of the participants, 86.3% were classified as general, 11.1% as potential high risk, and 2.6% as high risk for IA. The high risk IA group exhibited significantly higher rates of attention-deficit/hyperactivity disorder (42.9%), major depressive disorder (26.3%), and social anxiety (14.3%) as well as greater attentional and social difficulties. Effect sizes for group differences were small to moderate (ε²=0.041 for social problems; ε²=0.033 for attentional problems). IA scores were positively correlated with attentional difficulties and anxiety. Anxiety was a significant predictor of IA in the regression analysis.

Conclusion: Adolescents with high IA risk exhibited elevated psychiatric comorbidities and mental health difficulties, with anxiety showing an independent association with IA. These findings suggest incorporating anxiety-management components into IA prevention and care. Given the small sample size of the high risk IA group, caution is warranted when generalizing these findings.

Using scientometric and content-based approaches, this study explored the thematic structure and knowledge evolution in the application of artificial intelligence (AI) to autism spectrum disorder (ASD) in children and adolescents. A comprehensive search was conducted in the Scopus database up to June 30, 2025, using combined keyword sets related to ASD, AI, and child development, and 1401 English-language articles were retained. A bibliometric analysis was performed using VOSviewer to identify keyword co-occurrence patterns and citation linkages. The resulting thematic clusters were further analyzed through qualitative content examination. The analysis revealed a rapid growth in publications since 2015, with a surge after 2020, reflecting a growing interest in AI applications for ASD. Four important thematic clusters emerged: 1) AI-driven diagnostic models, 2) neuroimaging-based analysis, 3) early risk detection and behavioral assessment, and 4) emerging research on interventions and comorbidities, which remains comparatively limited. The United States, China, and the United Kingdom led in contributions, supported by active international collaborations. Highly cited and high-link-strength studies focused mainly on the use of deep learning in neuroimaging and early detection. Overall, the field demonstrates a strong diagnostic focus, increasing methodological sophistication, and interdisciplinary integration across computer science, neuroscience, and developmental psychology, leaving such areas as intervention and longitudinal tracking underexplored. These findings offer a comprehensive overview of the current landscape of the field and indicate critical opportunities for future development.

Objectives: Marijuana use (MU) and gambling are prevalent among adolescents, and marijuana products are becoming increasingly available and normalized globally. This study explored the relationships between early- (age <13 years), later- (age ≥13 years), and no-MU and substance use and violence among adolescents who gambled and did not gamble.

Methods: It analyzed data from the 2019 Youth Risk Behavior Surveillance survey (n=2015) on MU, gambling, demographics, substance use, and violence, using adjusted multivariate logistic regression models.

Results: The odds of current cigarette smoking, alcohol use, and heavy alcohol use; lifetime use of any substance and cocaine; current and lifetime electronic vapor product use; and physical fighting were higher across adolescents with early and later MU than those with no MU. Gambling adolescents with early-MU, compared to later- and no-MU, respectively, had greater odds of any substance use and prescription opiate misuse. Non-gambling adolescents with later-MU had higher odds of having experienced forced sexual intercourse than those with no-MU. MU by gambling status interactions were identified for prescription opiate misuse and any substance use, and having experienced bullying at school and forced sexual intercourse. However, while the simple main effects of MU on the odds of experiencing bullying among gamblers was approximately 3.9 times greater than that among non-gamblers, they were not statistically significant in either gambling group.

Conclusion: Early MU is associated with risky behaviors involving the use of other substances and violence, and its relationships with several factors differ according to gambling status. Reducing early engagement in addictive behaviors may be important for preventions against substance use disorders and interpersonal violence.

Objectives: This study explored how the Interaction of Person-Affect-Cognition-Execution (I-PACE) model can explain and address addictive behaviors in East Asian contexts.

Methods: Over the past decades, articles published in peer-reviewed journals were identified and reviewed by searching academic databases, including PubMed, Scopus, Web of Science, and Google Scholar. These articles were related to the I-PACE model and considered data from other Asian jurisdictions.

Results: Asian cultural factors within the I-PACE model may include 1) personal factors (academic stress, family expectations, and collectivistic values), 2) affective factors (shame, fear of failure, and social comparison), 3) cognitive factors (cultural beliefs about technology use and success), and 4) execution factors (parental control, technological restrictions, and school policies).

Conclusion: We propose specifying the I-PACE model to include cultural factors relevant to the East Asian environment. Such considerations could promote investigations into how addiction pathways involve Asian familial structures, societal expectations, and cultural norms.

Objectives: This study aimed to evaluate the validity and reliability of the Indonesian version of the South Oaks Gambling Screening (SOGS), the most widely used tool for screening gambling disorder (GD).

Methods: A national cross-sectional study was conducted between April and July 2021 among an Indonesian community sample. A total of 5810 respondents participated (mean age=21.74±5.68 years; 76.8% were women). The methodology included forward translation, expert panel discussions, back translation, face validity testing, a pilot study, and an assessment of the SOGS's psychometric properties. Factor structure was examined using exploratory and confirmatory factor analysis, and reliability was assessed using Cronbach's alpha.

Results: Factor analysis revealed that the Indonesian version of the SOGS consisted of four domains and demonstrated satisfactory goodness of fit (χ²=1270.72; df=166; p<0.001; RMSEA=0.048; CFI=0.99; TLI=0.99; SRMR=0.031). The SOGS also showed good internal consistency (Cronbach's alpha=0.879). Findings indicated that 2.05% of the sample met the criteria for gambling addiction. A significant association was observed between GD and age (p<0.001), sex (p<0.001), educational level (p<0.05), employment status (p<0.001), and types of gambling (p<0.001).

Conclusion: The Indonesian version of SOGS is a valid and reliable instrument for assessing GD in the Indonesian population.

Objectives: Given the disproportionate burden of gaming disorder (GD) on younger populations, there is a need to comprehensively evaluate the current evidence base around treatment for children and adolescents. This systematic review aimed to summarize the available literature on GD treatment in younger populations.

Methods: A systematic search of five databases was conducted. Studies were eligible if they 1) evaluated psychological or pharmacological interventions targeting GD in children, adolescents, or parents seeking help for their children; 2) had at least one outcome of GD severity or gaming duration/frequency; and 3) employed a randomized controlled trial or quasi-experimental design. Study quality was assessed using the Effective Public Health Practice Project tool.

Results: Thirty studies were included in the review, comprising 2157 participants. Interventions based on or delivered in combination with cognitive-behavioral therapy were the most frequently studied (n=19), while a diverse range of other treatments (e.g., pharmacotherapy, online psychoeducation, and equine-assisted therapy) were explored in fewer studies. Despite promising findings across studies, the overall quality of evidence was inconsistent, with many studies lacking randomization, control groups, and long-term follow-up. Additionally, cross-study comparisons may have been limited by the variability in GD measures across studies, with 19 different assessment tools identified.

Conclusion: Although research on the treatment of GD in children and adolescents has grown, it remains in its early stages. To advance evidence-based treatment, future research should prioritize methodologically rigorous designs, standardized outcome measures, and long-term follow-up assessments.