< 학술연구용역사업최종보고서 > 지역사회정신건강고위험군아동청소년추적관리코호트확대 (The follow-up and management system for children and adolescents at high-risk of mental health dwelling

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영아 사
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1 < 학술연구용역사업최종보고서 > 지역사회정신건강고위험군아동청소년추적관리코호트확대 (The follow-up and management system for children and adolescents at high-risk of mental health dwelling in community)

3 1) ) ) : SNS ) : ~ ,, - - 1, - -

4 3) ) , (35.3%). -, 9(37.5%), 6(25%), 9(25%) ) -, 18~6 80 SNS 60 CBCL 1, (28.07%). - SNS, 1:1. - ) , 169(70%)

5 - 169 CES-D 76(45%), SIQ 45(26.6%), SDQ 9(5.3%), 36(21.3%), 45(26.6%), 21(12.4%). -, ADHD (25.5%). - 2, 10 CCTT 2(20%), Stroop 7(70%), ATA 9(90%), WCST 3(30%), KEDI-WISC 4) -. -,.,.,,,.

6 1) Objectives The purpose of this study was to expand the cohort established by the study Development of a follow-up system of a community mental health high risk child and adolescent cohort to the infantile period, and apply the high risk assessment protocol and long-term follow up model, in order to detect and manage mental health high risk children at an earlier stage. 2) Methods ) Conduction System : 2 Detection of infants and children, adolescents with high susceptibility of mental health problems 3 Baseline assessment and detection of mental health high risk children 4 Long-term follow up system establishment through SNS services SNS ) Participants : 1 68 subjects from the cohort study whose phone number is available 2 A cohort consisting of 60 18months 18 year old subjects whose parents are in the vulnerable class, or whose parents have agreed to their child s mental health monitoring regardless of being in the vulnerable class - Subjects who live in Jung-gu seoul and who have more than 1 parent with mental disorder, mental retardation, or chronic or rare incurable disease - Subjects who live in Jung-gu seoul and whose mother has experience postpartum depression - Subjects who live in Jung-gu seoul and who have more than 1 parent from a different cultural background or have escaped North Korea - Subjects who live in Jung-gu seoul and are from a livelihood protection household - Subjects who live in Jung-gu seoul and whose parent agrees to mental health monitoring of their child

7 3) Study results ) Follow up of cohort - We monitored 68 high risk children from 9 districts in Seoul every 3 months by telephone, and we re-assessed 24 (35.3%) among 68 of the original cohort at the 1 year period in November. - Among them, 9 (37.5%) met the high risk criteria, 6 (25%) met the borderline risk criteria, and 9 (25%) met the normal children criteria, showing a similar ratio with We confirmed the need for a systematic system for continuous cohort follow-up. ) Infants - We recruited 80 infants (18months ~ 6 year old) who are currently using the service of a community health center/ dietetic service due to vulnerability by diseases, poverty or multicultural backgrounds and 60 from the same age span by SNS. We sent the 1 st assessment form based on CBCL, and explained the results face-to-face and a total of 57 participated in the cohort study. -There were no significant differences between infants and toddlers from the vulnerable class who were already using public services and those who were not, based on the parent questionnaire. - Among the 57 in the infant cohort, 16 (2807%) were classified as mental health high risk. - We confirmed the effectiveness of SNS in the process of recruitment and assessment of the cohort, and we suggest that it is also an effective model for long-term cohort follow-up as it makes 1:1 communication with the parents possible. We also expect that mental health services along with nutritional-physical health services will promote participation in the long term cohort management. ) Community Center for children and adolescents - We assessed 230 children and adolescents from 9 high-risk community mental health centers, and 169 (70%) met the high-risk criteria and were enrolled in the study cohort. - Among the 169 high risk participants, 76 (45%) by CES-D depression scale, 45 (26.6%) from the SIQ suicidality scale, 9 (5.3%) from the SDQ hyperactivity scale, 36 (21.3%) with emotional symptoms, 45 (26.6%) with conduct behavior, 21 (12.4%) with peer problems were identified. - When analyzing the baseline assessment done by homeschool teachers, 68 (25.5%) among the 267 who underwent ADHD assessment were suspected to have ADHD.

8 - When analyzing the 2 nd assessment results, among the 10 who underwent neuropsychological tests, 2 (20%) from the CCTT, 7 (70%) from the Stroop, 9 (90%) from the ATA, 3 (30%) from the WCST exceeded the cut-off scores, and all had normal range IQ from the KEDI-WISC but there was some fluctuation in subtests to the level of borderline or retardation. 4) Expected effects - We suggest a new model by expanding the original high risk child and adolescent cohort. We propose a integrated model by combining new methodologies in infantile mental health examination and physical health-nutritional services, and also propose that community mental health centers can function as a new route to access the socioecomonical vulnerability class. We indent to establish a more wide-rage high risk cohort in the future.

14 ,, %, 8.98%, 10~15%,,,..,

15 .. (, 2009).,. 8~10% ,672 ( 1,645, 649, 378) -(attention deficit hyperactivity disorder, ADHD) 13.3%, 23%, 7.4%, 1 26%.,.,.,,.,,,,., 2011 ADHD 300.,.

16 %(29) %,. 14,.,.

17 (CAT) 1 - (STAI) 2 CoA 3 (K-LDES) 1 2 (K-CBCL) 3 ADHD (K-ARS)

19 1),, 2) 1) Korean version for Learning Disability Evaluation Scale (K-LDES): 2) (CAT):, 1) Children' Depression Inventory (CDI-II): 2) Korean Child Behavior Checklist (K-CBCL): 3) ADHD Rating Scale (ARS): 4) Internet Addiction Test (IAT): 1) (The Korean Version of Children of Alcoholics Screening Test: CAST-K) 2)

20 1),, 2) 1) (CAT):, 1) Children' Depression Inventory (CDI-II): -> Beck Depression Inventory-II (BDI-II): ((13 ) CDI-II BDI-II ) 2) Korean Child Behavior Checklist (K-CBCL): 3) ADHD Rating Scale (ARS): 4) Internet Addiction Test (IAT): 1) (The Korean Version of Children of Alcoholics Screening Test: CAST-K) 2) 1),, 2) 1) (CAT):, 1) Beck Depression Inventory-II (BDI-II): 2) Korean Child Behavior Checklist (K-CBCL): 3) Korean-Internet Addiction Test (IAT): 4) Peters Delusions Inventory 21 (PDI-21) 5) Launay-Slade Hallucination Scale-Revised (LSHS-R) 6) - (YSR)

23 1) 2), SNS 1) SNS 2) 3 3) 6 4) 1:1 SNS 1) 404 SNS 173, 18 ~6 140 CBCL

24 57. 2) 9 7~ , ) ,

25 KM-CHAT (Korean Modified Checklist for Autism in Toddlers) CBCL Beck Depression Inventory-II (BDI-II) CBCL Beck Depression Inventory-II (BDI-II) ADHD (Korean ADHD Rating Scale, K-ARS) CBCL 6-18 Beck Depression Inventory-II (BDI-II)

26 (Strengths and Difficulties Questionnaire, SDQ-Kr) ADHD (Korean ADHD Rating Scale, K-ARS) (Strengths and Difficulties Questionnaire, SDQ-Kr) ADHD (Korean ADHD Rating Scale, K-ARS) (The Center for Epidemiologic Studies-Depression Scale, CES-D) (The Reynolds ideation, SIQ_Reynolds) (Strengths and Difficulties Questionnaire, SDQ-Kr) (Basic Empathy Scale, BES)

28 .

29 ( // /)

30 1) Korean version for Learning Disability Evaluation Scale (K-LDES): 2) (CAT):, 1) Children' Depression Inventory (CDI-II): 2) Korean Child Behavior Checklist (K-CBCL): 3) ADHD Rating Scale (ARS): 4) Internet Addiction Test (IAT): 1) (The Korean Version of Children of Alcoholics Screening Test: CAST-K) 2) 1) (CAT):, 1) Children' Depression Inventory (CDI-II): -> Beck Depression Inventory-II (BDI-II): ( (13 ) CDI-II BDI-II ) 2) Korean Child Behavior Checklist (K-CBCL): 3) ADHD Rating Scale (ARS): 4) Internet Addiction Test (IAT): 1) (The Korean Version of Children of Alcoholics Screening Test: CAST-K) 2)

31 1) Beck Depression Inventory-II (BDI-II): 2) Korean Child Behavior Checklist (K-CBCL): 3) Korean-Internet Addiction Test (IAT): 4) Peters Delusions Inventory 21 (PDI-21) 5) Launay-Slade Hallucination Scale-Revised (LSHS-R) 6) - (YSR) 1) (The Korean Version of Children of Alcoholics Screening Test: CAST-K) 2) 11 2 < >, < >.

32 (executiv e function) (response inhibition) Advenced Test of Attention, ATA Continuous Performance Test(CPT) 6~15 16 (working memory) Children's color trails test (CCTT) 6~15 Trail Making test, TMT A, B 16 (conflict monitoring) Color and Word test (Stroop) (EXIT)Stroo p 6~15 16

33 (Cognitive flexibility) Wisconsin Card Sorting Test (WCST) 7 Comprehensive attentional test (CAT) 6~16 1) Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K): Kaufman (1997) DSM-IV 32 (semi-structured interview). Kim (2004) ADHD, (tic disorder), ODD,,. 0, 1, 2, 3. (threshold diagnosis) (sub-threshold diagnosis) 2, 3 DSM-IV, 2. (definite diagnosis), (probable diagnosis).

34 2) (Korean Child Behavior Checklist: K-CBCL): Achenbach (1991) (, 1990;, 1996). K-CBCL T-.,,.,, /,,,,,,,,,, 13. 3) ADHD (Korean ADHD Rating Scale-IV: K-ARS): DuPaul(1991) ADHD (, 2002). K-ARS DSM-IV ADHD 18. 0, 1, 2, ) (Disruptive Behavior Disorder Scale according to DSM-IV: DBDS): DSM-IV ADHD, ODD, CD. ADHD 18, ODD 8, CD , 1, 2, 3.

35 5) : -(Clinical Global Impression Scale-Severity: CGI-S), -(Clinical Global Impression Scale-Improvement: CGI-I),. (Children s Global Assessment Scale). 6) (Children's Depression Inventory, CDI): Kovacs Beck(1997),,, (BDI). 27, 0~2. 7) Beck (Beck Depression Inventory, BDI): Beck 1961,,,. 21, ) (Child Mania Rating Scale, CMRS):, 21. 0, 1, 2, 3. 9) (Young's Internet Addiction Scale, YIAS): Young(1998). 20, 1( ) 5( ). 29~39, 40~69, 70~100.

36 . 1) Advenced Test of Attention, ATA / Continuous Performance Test(CPT): ATA (continuous performance test: CPT) (2000). (omission error), (commission error), (mean reaction time), (standard deviation of reaction time) 4. 2) Children's color trails test (CCTT)/ Trail Making test, TMT A, B:,. (TMT) A 1 25, TMT B (,, ). (CCTT). CCTT , CCTT ,.. 3) Color and Word test/ Stroop:. 3, 45 (W), (C). - (CW). -

37 ., (EXIT), 1)( (C) ), 2)( ), 3) (- (CW) ),. 4) Wisconsin Card Sorting Test (WCST): 4 128,,,. 6, 1 10., 1,,, total error, perseveration response, perseveration error. 5) Comprehensive attentional test (CAT):,,,,, ) : Pharis(1978),,,,,,,, 13 5 (Pharis Self Confidence Scale: PSCS)., 11 55,. 2) KM-CHAT(Korean Modified Checklist for Autism in Toddlers)

38 : KM-CHAT ,, (2, 7, 9, 13, 14, 15 ) (Robins et al, 2001). SPSS..,.

39 ()

40 (84.2%), 53(92.9%)

41 ., 29(50.9%), 32(56.1%)

42 , 19.3%(11) %, 17.5%

43 -12, 13-24, , 13,,

44 59 (25.7) 64 (24.0) 106 (46.1) 127 (47.6) 65 (28.3) 76 (28.5)

45 (%) () 1 (4.2) 106 (54.2) 65 (41.7) (2.26) 24 (100) 1, 16. CBCL T : T 64 : T : T 70 :

46 KM-CHAT BDI 1) 3 2) 2, 7, 9, 13, 14, : 24 : 1) ,

47 () KM-CHAT , 147. CES-D 0~15 : 16~24 : 25 : SIQ 0~5.

48 SDQ-KR BES K-ARS. 20 : 1) 10,, 40. 2) 17, 16, 20. : 1,2,4,5,7,8,11,13,15,17,18 : 3,6,9,10,12,14,16,19, )

49 2), 169 CES-D 76(45%), SIQ 45 (26.6%), SDQ 9(5.3%), 36(21.3%), 45(26.6%), 21(12.4%). 2. < 2>, ADHD (25.5%)., 134(50.2%), 11(4.1%), 11(4.1%), 22(8.2%), 10(3.7%). < 3>

2),,.. (13.6% vs. 17.9% vs. 18.5%).. χ 2 P 36(61.0) 77(72.6) 41(63.1) 23(39.0) 29(27.4) 24(36.9) 0.035 0.851 51(86.

50 2),,.. (13.6% vs. 17.9% vs. 18.5%).. χ 2 P 36(61.0) 77(72.6) 41(63.1) 23(39.0) 29(27.4) 24(36.9) (86.4) 87(82.1) 53(81.5) 8(13.6) 19(17.9) 12(18.5) (47.5) 48(45.3) 39(60.0) 31(52.5) 58(54.7) 26(40.0)

51 57(96.6) 2(3.4) 50(84.7) 9(15.3) 48(81.4) 11(18.6) 50(84.7) 9(15.3) 103(97.2) 3(2.8) 96(90.6) 10(9.4) 91(85.8) 15(14.2) 101(95.3) 5(4.7) 61(93.8) 4(6.2) 50(76.9) 15(23.1) 49(75.4) 16(24.6) 60(92.3) 5(7.7)

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55 ,,,,, ~6 9~ ~24 18~29 30~36 42~48 42~53 54~60 54~65 66~71 - ( :, : ) -

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65 Ⅲ,, 2013,, 2014,, ,,,,. :., 1995: 34(4), ,.., 2003: 22(1) J Korean Med Assoc 2009: ,, : :. 2005, Achenbach TM, Edelbrock C. Manual for the child behavior checklist/4-18 and 1991 profile. Burlington: University of Vermont;1991. Beck. A. T., Kovac, M., & weissman, A. Assessment of Suicidal Intention: the

66 Scale for suicide ideation. Journal of Consulting and clinical Psychology. 1979;47: Beck, A. T., Epstein. N., Brown G., Steer. R. A. An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psycholgy. 1988;56(6); Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. Journal of Personality Assessment. 1996;67(3): Caplan G: Principles of Preventive Psychiatry. NY, Basic books, Inc.,1964 DuPaul GJ. Parent and teacher ratings of ADHD symptoms: psychometric properties in a community-based sample. J Clin Child Psychol 1991;20: Ha EH, Oh KJ, Hong KE, Lee HL. Reconstruction of the behavior problem scales of the Korean CBCL. The Seoul J of Psychiatry. 1996;20: Hong KE, Song HH, Kim ZS, Hong KJ, Park SS. An epidemiological study of behavior problems in Korean elementary school children by CBCL. J Korean Neuropsychiatr Assoc. 1988;27: Jones, JW. The Children of Alcoholics Screening Test: Test manual. Chicago: Camelot Unlimited, Jung, H.Y., Chang, J.S., Yi, J.S., Hwang, S., Shin, H.K., Kim, J.H., Cho, I.H., Kim, Y.S. Measuring psychosis proneness in a nonclinical Korean population: is the Peters et al. Delusions Inventory useful for assessing high-risk individuals? Comprehensive Psychiatry. 2008;49:

67 Kim YN, Chang JS, Hwang S, Yi JS, Cho IH, Jung HY. Psychometricproperties of Peters et al. Delusions Inventory-21 in adolescence. Psychiatry Research. 2013;207(3): Kim YS, So YK, Noh JS, Choi NK, Kim SJ, Koh YJ. Normative data on the Korean ADHD Rating Scales (K-ARS) for parents and teacher. J Korean Neuropsychiatr Assoc. 2003;42: Lazarus, R. S., Folkman, S. Stress, appraisal, and coping, Research, Theory, and Measurement in nursing, Liptak GS et al. Health care utilization and expenditures for children with autism: data from U.S. national samples. J Autism Dev Disord Oct;36(7): Mrazek, PJ and Haggerty, RJ (eds.) : Institute of medicine:reducing Risks for Mental Disorders:Frontiers for Preventive Intervention Research. Washington, DC, National Academy Press, Oh KJ, Lee HL. Development of korean child behavior checklist: a preliminary study. J Korean Neuropsychiatr Assoc 1990;29: Peters, E.R, Joseph, S.A, Garety, P.A. Measurement of delusional ideation in the normal population: Introducing the PDI (Peters et al. Delusions Inventory). Schizophrenia Bulletin. 1999; 25(3): Peters E, Joseph S, Day S, Garety P. Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). Schizophr Bulletin. 2004;30(4): Remschmidt H. Belfer M. Mental health care for children and adolescents Worldwide: A review. World Psychiatry, 2005, 4:3:

68 Rosenberg. Society and the adolescent self-image, Princeton, NJ: Princeton University Press So YK, Noh JS, Kim YS, Ko SG, Koh YJ. The reliability and validity of Korean parent and teacher ADHD rating scale. J Korean Neuropsychiatr Assoc. 2002;41: Yoo HI, Lee JS, et al. Standardization of the Comprehensive Attention Test for the Korean Children and Adolescents. J Kor Acad Child Adolesc Psychiatry 2009;20:68-75.

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