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

Complex post-traumatic stress disorder (Complex PTSD) in pediatric patients is challenging to manage, particularly when conventional therapeutic approaches are insufficient. We report the case of Miss A, a 15-year-old girl with a history of severe neglect and abuse, adopted at age 5, who presented with frequent reliving of trauma memories, significant emotional dysregulation, dissociative episodes, recurrent self-harm, and aggression. Her treatment was complicated by comorbid mild-grade learning disability and suspected autism spectrum disorder. Initial management with promethazine, melatonin, and lorazepam, and later aripiprazole and fluoxetine provided limited relief. Following hospital readmission, guanfacine, an alpha-2 adrenergic agonist, was initiated. Miss A demonstrated a marked reduction in emotional dysregulation, self-harm, aggression, and suicidal thoughts, suggesting that guanfacine may offer significant benefits for managing Complex PTSD in such cases. This case underscores the difficulties in treating Complex PTSD with comorbid conditions, and highlights guanfacine as a potential adjunct therapy. However, further research is required to validate its efficacy and safety.

Objectives: Because appetite-regulating hormones are implicated in neuronal survival, growth, and differentiation, they have been suggested to play a role in anxiety disorders. To date, few studies have focused on the association between these hormones and anxiety disorders in children. This study investigated the potential differences in leptin, ghrelin, and nesfatin-1 serum levels in drug-naïve children with anxiety disorders, including social anxiety disorder, separation anxiety disorder, and generalized anxiety disorder, and in healthy controls.

Methods: This study included 45 children (14 boys and 31 girls) with anxiety disorders and 35 healthy controls (13 boys and 22 girls) aged 8-18 years. The severity of anxiety disorders and additional symptoms were evaluated using the Revised Child Anxiety and Depression Scales-Child Version. Enzyme-linked immunosorbent assay (ELISA) was used to evaluate leptin, ghrelin, and nesfatin-1 serum levels.

Results: Leptin levels were significantly higher in children with anxiety disorders than in the control group, and ghrelin and nesfatin-1 levels were significantly lower in children with anxiety disorders than in the control group for girls and for the entire sample. However, only low nesfatin-1 levels were significantly associated with anxiety disorders in boys. In the entire sample, potential confounders such as age, sex, body mass index, and the severity of depressive symptoms were controlled for, and the results were the same for ghrelin and nesfatin-1 levels. However, the difference in leptin levels between groups was not significant.

Conclusion: These findings suggest that dysregulation of ghrelin and nesfatin-1 concentrations may be related to the etiopathogenesis of childhood anxiety disorders.

Objectives: This study aimed to explain the roles of physical and verbal aggression, emotional immaturity, and lying behavior in the predictive relationship between emotional abuse and delinquent tendencies among juveniles and students in Punjab, Pakistan.

Methods: Data were collected from 232 juveniles incarcerated in the Borstal Jails of Faisalabad and Bahawalpur. A comparative sample of 276 students from government schools was collected through purposive sampling. The comparative sample was matched for socioeconomic status, gender, location, and age. Translated (Urdu) versions of the standardized scales were used to measure the respective constructs. Path analysis was conducted to determine the mediating effects of lying (as a personality trait), emotional immaturity, and physical-verbal aggression on the relationship between emotional abuse and delinquent tendencies. Multigroup analysis was performed to determine the strength and significance of each path for juveniles and students.

Results: Emotional abuse positively predicted delinquent tendencies and emotional maturity, lying as a personality trait, and physical-verbal aggression mediated this relationship among juveniles and students. A decline in emotional maturity was a stronger predictor of delinquent tendencies among juveniles, whereas physical-verbal aggression played a stronger role for students.

Conclusion: This study demonstrates the indirect effects of emotional abuse on delinquent tendencies. This study also highlights the intense effect of emotional abuse on juvenile delinquents' emotional maturity and supports the importance of utilizing positive methods when dealing with adolescents, especially school personnel and clinical psychologists who interact with adolescents with problematic behaviors.

Objectives: This study investigated the relationship between exposure to endocrine-disrupting chemicals (EDCs), specifically phthalates, bisphenol A, bisphenol F, and bisphenol S, and the severity of attention-deficit/hyperactivity disorder (ADHD) symptoms using neuropsychological tests in children diagnosed with ADHD.

Methods: This study included 67 medication-naïve children with ADHD aged 6-16 years. The urinary concentrations of EDCs were measured, and ADHD symptom severity was evaluated using neuropsychological tests and clinical symptom scale measurements. The Jonckheere-Terpstra test, Pearson and Spearman correlation analyses, linear regression models, and multiple regression models were used to examine the relationship between EDC exposure and ADHD symptoms.

Results: A significant correlation was observed between urinary phthalate metabolite concentrations and commission error T-scores in the visual Advanced Test of Attention test. No significant associations were found with other neuropsychological indicators or bisphenol levels.

Conclusion: Phthalate exposure affects impulsivity in children with ADHD, which is consistent with the results of previous studies that used parental surveys. However, bisphenols are not clearly associated with ADHD symptoms, which is consistent with the results of previous studies.

This review examines the therapeutic potential of neuromodulation methods, including neurofeedback, transcranial direct current stimulation (tDCS), and transcranial magnetic stimulation (TMS), as non-pharmacological interventions for children with attention-deficit/hyperactivity disorder (ADHD). A comprehensive review of current studies was conducted, focusing on each technique's mechanism, application, and efficacy in managing ADHD symptoms and cognitive deficits. Studies included human participants with ADHD, evaluating changes in symptom severity and cognitive outcomes. Neurofeedback demonstrated efficacy in symptom reduction, particularly when combined with pharmacotherapy, yielding sustained improvements. tDCS showed moderate efficacy, especially in attention and impulsivity control; however, variability in protocols and pediatric response highlights the need for standardization. TMS exhibited mixed outcomes, with high-frequency TMS targeting the dorsolateral prefrontal cortex indicating potential cognitive benefits, though results were inconsistent across studies. Neuromodulation presents a promising complementary approach for ADHD treatment in children, potentially addressing limitations of pharmacotherapy. Future research should focus on optimizing stimulation parameters, increasing sample sizes, and refining methodologies to establish neuromodulation as part of standard ADHD treatment protocols.

Objectives: This study examined the neurocognitive profiles of early adulthood attention-deficit/hyperactivity disorder (ADHD) patients using the Korean version of the Wechsler Adult Intelligence Scale, 4th Edition (K-WAIS-IV) and Continuous Performance Test 3rd Edition (CPT-3) assessment results.

Methods: A total of 105 individuals underwent the K-WAIS-IV assessment, and 68 participants completed the CPT-3. We examined the differences between intelligence subindex scores using paired t-tests and applied Pearson's correlation analysis to determine the correlation between the K-WAIS-IV and CPT-3 scores.

Results: Working Memory Index scores were significantly lower than Verbal Comprehension Index scores, whereas Processing Speed Index (PSI) scores were significantly lower than all three other subindex scores. Significant negative correlations were found between all four K-WAIS-IV subindex scores and the CPT-3 scores for Detectability, Omissions, Commissions, Perseverations, Hit Reaction Time, Hit Reaction Time Standard Deviation, and Variability.

Conclusion: The PSI of the K-WAIS-IV can be considered a useful predictor in early adulthood ADHD patients combined with the CPT-3 examination.

Objectives: Depression and anxiety are emotional difficulties that are common among adolescents. Adolescents suffering from depression and anxiety can exhibit problems such as antisocial behavior, aggression, and academic slump. This study aimed to explore the factors influencing adolescents' depression and anxiety during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: This study examined the data from an online student health survey conducted by the Ministry of Education in 2022. The survey participants were 131194 students ranging from the first grade of middle school to the third grade of high school. The influence of each variable on depression and anxiety was examined.

Results: Factors that predicted depression and anxiety were sex (female), grade level (higher), financial difficulties (existing or unknown), physical activity (higher), sleep time (shorter), media usage time (higher), family/friends relationship (worse), and change in the health status of family, friends, and oneself due to COVID-19 (worse).

Conclusion: These results may help identify patterns of depression and anxiety among adolescents caused by COVID-19 and maximize the intervention effect.

Adolescents diagnosed with autism spectrum disorder (ASD) often encounter significant challenges, particularly aggressive behaviors that persist into adulthood and profoundly affect their daily functioning and quality of life. These behaviors not only pose hurdles for affected individuals but also present considerable challenges for caregivers and families. Managing aggression in adolescents with ASD requires comprehensive treatment approaches encompassing both non-pharmacological and pharmacological interventions. This paper reviews current interventions that have proven to be effective through empirical studies in managing aggression among adolescents with ASD. By synthesizing evidence-based practices, this study underscores the importance of a multidisciplinary approach involving medical, psychological, and educational interventions to effectively manage aggression among adolescents with ASD. It aimed to inform clinicians, educators, and caregivers of practical strategies and evidence-based interventions to address aggression in this population.