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

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.

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.