KISEP Original Articles Korean J Child & Adol Psychiatr 8 273~286 주의력결핍 과잉행동장애아동에서 Methylphenidate 에의한사건관련전위와 연속과제수행변화사이의상관성 RELATIONSHIP BET

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1 KISEP Original Articles Korean J Child & Adol Psychiatr 8273~286 주의력결핍 과잉행동장애아동에서 Methylphenidate 에의한사건관련전위와 연속과제수행변화사이의상관성 RELATIONSHIP BETWEEN CHANGES IN EVENT-RELATED POTENTIALS AND CHANGES IN CONTINUOUS PERFORMANCE TEST UNDER THE INFLUENCE OF METHYLPHENIDATE IN ATTENTION-DEFICITHYPERACTIVITY DISORDER 이미숙 * 최영 * 이무석 * Mi Suk Lee, M.D.,* Young Choi, M.D.,* Mu Suk Lee, M.D.* 요약 중심단어 서 론 Department of Psychiatry, Chonnam National University Hospital, Kwangju Corresponding author 273

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3 1. 연구대상 연구대상및방법 2. 연구절차 275

4 3. 도구 1) 부모평정척도 2) 신경심리학적검사 3) 사건관련전위 276

5 4. 자료의분석 결 1. 사건관련전위 1) 잠복기 과 Table 1. Characteristics of the subjects SexMaleFemale N Median2575% HandednessRtLt 110 Previous stimulant therapyyesno 101 Family historyyesno 011 Physical illness history yesno 011 Agemonth Educationyear KEDI-WISC Full scale IQ* KEDI-WISC Verbal IQ* KEDI-WISC Performance IQ* CAPRS Methylphenidate dosage *Korean Wechsler Intelligent Scale for Children Conner s Abbreviated Parent Rating Scale 277

6 2) 진폭 Table 2. Effects of methylphenidate on latencies of N1, P2, N2, P3 waves to the nontarget stimuli at Cz, Fz, Pz, Oz leads SubjectsN11 LeadsERP waves N1 P2 N2 P3 Median2575% Cz Before Fz Before * Pz Before Oz Before *.01 Note:ERP waves:event-related potential waves Table 3. Effects of methylphenidate on latencies of N1, P2, N2, P3 waves to the target stimuli at Cz, Fz, Pz, Oz leads SubjectsN11 LeadsERP waves N1 P2 N2 P3 Median2575% Cz Before Fz Before Pz Before Oz Before Note:ERP waves:event-related potential waves 278

7 2. 연속과제수행검사 Table 4. Effects of methylphenidate on amplitudes of N1, P2, N2, P3 waves to the nontarget stimuli at Cz, Fz, Pz, Oz leads SubjectsN11 LeadsERP waves V Cz Before Fz Before Pz Before Oz Before N1 P2 N2 P3 Median2575% Note:ERP waves:event-related potential waves Table 5. Effects of methylphenidate on amplitudes of N1, P2, N2, P3 waves to the target stimuli at Cz, Fz, Pz, Oz leads SubjectsN11 LeadsERP waves N1 P2 N2 P3 V Median2575% Cz Before ** Fz Before Pz Before * Oz Before * *.05 **.01 Note:ERP waves:event-related potential waves 279

8 Table 6. Effects of methylphenidate on continuous performance test CPT SubjectsN11 Paradigm OE CE Hit RT Hits d X Before ** 18.00* * 3.01** AX Before ** *.05 **.01 Note:CPT:Continuous performance test OE:Omission error CE:Commission error Hits:The number of responses to targets Hit RT:Hit reaction time d :Sensitivity β:criterion bias Table 7. Correlation between changes in event-related po-tential and changes in continuous performance test ERP changescpt changes X Paradigm AX Paradigm OE CE Hits d CE d CTAP FSLP * OTAP PTAP * *.05 Note:CPT:Continuous performance test X-Paradigm:CPT X-Paradigm AX-Paradigm:CPT AX-Pardigm OE:Omission Error CE:Commission Error Hits:The number of correct response to targets d :Perceptual sensitivity β:criterion bias ERP:Event related potential CTAP3:P3 amplitude to target stimuli at Cz FSLP3:P3 latency to nontarget stimuli at Fz OTAP2:P2 amplitude to target stimuli at Oz PTAP2:P2 amplitude to target stimuli at Pz 3. 사건관련전위변화와연속과제수행변화사이의관계 고찰 280

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11 결론 References 안동현 홍강의 오경자 신민섭 유보춘 정경미 283

12 (1992):Methylphenidate와 Imipramine 투여에따른주의력결핍 과잉운동장애환자의행동및인지기능변화에대한연구. 소아 청소년정신의학 3:26-45 오경자 (1990): 주의력결핍 과잉활동장애의평가. 소아 청소년정신의학 1:65-76 정경미 (1991): 과제유형과피이드백이주의력결핍과잉활동아의주의과정에미치는효과. 연세대학교석사논문 Bakley RA(1990):Attention deficit hyperactivity disorder. A handbook for diagnosis and treatment. New York: Guilford Press, Campbell L, Malone MA, Kershner JR, Roberts W, Humphriews T, Logan WJ(1996):Methylphenidate slows right hemisphere processing in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacology 6: Chee P, Logan G, Schachar R, Lindsay P, Wachsmuth R(1989):Effects of event rate and display time on sustained attention in hyperactive, normal, and control children. Journal of Abnormal Child Psychology 17: Conners CK(1995):Conner s continuous performance test. Multi-health System Inc, 74 Coons HW, Peloquin LJ, Klorman R, Bauer LO, Richard MR, Perlmutter RA, Salzman LF(1981): Effect of methylphenidate on young adult s vigilance and event-related potentials. Electroencephalography Clin Neurophysiol 51: Coons HW, Klorman R, Borgstedt AD(1986):Effect of methylphenidate on adolescents with a childhood history of attention deficit disorder:ii. Information processing. J Am Child Adolesec Psychiatry 4: Corkum PV, Siegel LS(1993):Is the continuous performance task a valuable research tool for use with children with attention-deficit-hyperactivity disorder? J Child Psychol Psychiatry 34: Davies DR, Parasuraman R(1981):The psychology of vigilance. Toronto:Academic Press Dennis PC(1996):Attention deficit disorder:a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 35: Douglas VI(1983):Attentional and cognitive problems. In Developmental Neuropsychiatry, Rutter M(ed), Guilford, New York, Dykman RA, Holocomb PJ, Ackerman PT, McCray DS(1983):Auditory ERP augmentation-reduction and methylphenidate dosage needs in attention and reading disordered children. Psychiatry Research 9: Giedd JN, Castenalos FX, Korzuch P, King AC, Hamburger SD, Rapoport JL(1994):Quantitative morphology of the corpus callosum in attention deficit hyperactivity disorder. Am J Psychiatry 151: Haider M, Spong P, Lindsley DB(1964):Attention, vigilance, and cortical evoked-potentials in humans. Science 145: Halliday R, Callaway E, Naylor H(1983):Visual evoked potential changes induced by methylphenidate in hyperactive children:dose/response effects. Electroencephalography. Clin Neurophysiol 55: Halliday R, Rosenthal JH, Naylor H, Callaway E (1983):Averaged evoked potential predictors of clinical improvement in hyperactive children:dose/ response effects. Electoencephalography Clin Neurophysiol 55: Hall RA, Griffin RB, Meyer DL, Hopkins KH, Rapport M(1976):Evoked potentials, stimulus intensity and drug treatment in hyperkinesis. Psychophysiology 13: Holcomb PJ, Ackerman PT, Dykman RA(1985): Cognitive event-related brain potentials in children with attention and reading deficits. Psychophysiology 22: Hynd GW, Semrud-Clikeman M, Loryss AR, Novey ES, Elioplus D(1990):Brain morphology in developmental dyslexia and attention deficit disorder with hyperactivity. Arch Neurology Kathleen O, Abramowttz A, Robin M, Mina D(1997): Effects of methylphenidiate on attention and nonverbal learning in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 36: Kinsbourne M, Swanson JM(1979):Models of hyperactivity. In:Hyperactivity in children:etiology, measurement, and treatment implication, Trites RL, ed. Baltimore:University Park Press, 1-20 Kirby EA, VandenBerg SP, Sullins W(1993):Evaluation of a continuous performance test for assessing ADHD. Poster presented at the 10 lst Annual Convention of the American Psychological Association, Toronto, Canada. Klorman R, Brumaghim JT, Salzman LF, Strauss J, 284

13 Borgstedt AD, McBride MC, Stuart L(1989): Comparative effects of methylphenidate on attention deficit hyperactivity disorder with and without aggressive/noncompliant features. Psychopharmacology Bulletin 25: Klorman R(1991):Cognitive event-related potentials in attention deficit disorder J Learn Disabil Klorman R, Salzman LF, Bauer LO, Coons HW, Borgstedt AD, Halpern WI(1983):Effects of two doses of methylphenidate on cross-situational and borderline hyperactive children s evoked potentials. Electroencephalography Clin Neurophysiol 56: Klorman R, Salzman LF, Pass HL, Borgstedt AD, Dainer KB(1979):Effects of methylphenidate on hyperactive children s evoked responses during passive and active attention. Psychophysiology 16:23-29 Koelega HS, Verbaten MN(1991):Event-related brain potentials and vigilance performance:dissociations abound, a review. Perceptual and Motor Skills 72: Kupietz SS, Richardson E(1978):Children s vigilance performance and inattentiveness in the classroom. J Child Psychol Psychiatry 19: Kupietz SS, Winsberg BG, Richardson S, Steven M, Mendell N(1987):Effects of methylphenidate dosages in hyperactive reading-disabled children:i. Behavior and cognitive performance effects. J Am Acad Child Adolesc Psychiatry 23:70-77 Michael RL, Klorman R, Salzman LF, Borgstedt AD, Dainer KB(1981):Normalizing effects of methylphenidate on hyperactive children s vigilance performance and evoked potentials. Psychology 18: Parasuraman R, Davies DR(1984):Varieties of attention. Toronto:Academic Press Picton TW, Hillyard SA(1988):Endogenous eventrelated potentials. In Handbook of Electroencephalography Clin Neurophysiol, 3, Picto TW(ed), Elsevier, Amsterdam, Rapport MD, Kelly KL(1991):Psychostimulant effects on learning and cognitive function:finding and implications to children with attention deficit hyperactivity disorder. Clinical Psychology Review 11: Robaey P, Breton F, Dugas M, Renault B(1992):An event-related potential study of controlled and automatic proccesses in 6-8 year boys with attention deficit hyperactivity disorder. Electroencephalography Clin Neurophysiol 82: Sapiro S, Herod LA(1994):Combining visual and auditory tasks in the assessment of attention-deficit hyperactivity disorder. Disruptive Behavior Disorders in Childhood, Dinald KR(ed), Plenum Press, New York, Satterfield JH, Schell AM, Nicholas T, Backs RW (1988):Topographic study of auditory event-related potentials in normal boys and boys with attention deficit disorder with hyperactivity. Psychophysiology 25: Solanto MV, Wender EH, Bartell SS(1997):Effects of methylphenidate and behavioral contingencies on sustained attention in attention-deficit hyperactivity disorder:a test of the reward dysfunction hypothesis. J Child Adolesc Psychopharmacol 7: Sprague RL, Sleator EK(1977):Methylphenidate in hyperactive children:difference in dose effects on learning and social behavior. Science 198: Sutton S, Braren M, Zubin J(1965):Evoked potential correlates of stimulus uncertainty. Science 150: Swanson HL, Cooney JB(1989):Relationship between intelligence and vigilance in children. J School Psychology 27: Sykes DH, Douglas VI, Weiss G, Minde KK(1971): Attention hyperactive children and the effect of Ritalin. J Child Psychol Psychiatry 12: Verbaten MN, Overtoom CCE, Koelega HS, Swaab- Barneveld H, van der Gaag RJ, Buitelaar J, van Engeland H(1994):Methylphenidate influences on both early and late ERP waves of ADHD children in a continuous performance test. J Abn Child Psychology 22: Wilkinson RT, Haines ER(1970):Evoked response correlates of expectancy during vigilance. Acta Psychologica 33: Zametkin AJ, Nordal TE, Gross M, et al(1990): Cerebral glucose metabolism in adults with hyperactivity of childhood onset. N Engl J Med 323:

14 ABSTRACT Korean J Child & Adol Psychiatr 8273~286, 1997 RELATIONSHIP BETWEEN CHANGES IN EVENT-RELATED POTENTIALS AND CHANGES IN CONTINUOUS PERFORMANCE TEST UNDER THE INFLUENCE OF METHYLPHENIDATE IN ATTENTION-DEFICITHYPERACTIVITY DISORDER Mi Suk Lee, M.D., Young Choi, M.D., Mu Suk Lee, M.D. Department of Psychiatry, Chonnam National University Hospital, Kwangju ObjectiveThis study was designed to evaluate effects of methylphenidatemph on event-related potentialserp and continuous performance testcpt in attention-deficit hyperactivity disorder ADHD and to see the correlation between changes in ERP and changes in performance. MethodERP and CPT were used to examine the acute effects of MPH0.5mgkg in eleven ADHD boys89103 months old. Results 1 MPH administration, P3 latency to nontarget stimuli at Fz was significantly decreased p0.01 and P2 amplitudes to target stimuli at Pz and at Oz and P3 amplitude to target stimuli at Cz were significantly increasedp Commission error and omission error in the CPT-X and commission error in the CPT-AX were decreasedp0.01, and hits and perceptual sensitivityd in the CPT-X and din the CPT-AX were increasedp The change of P3 latency to nontarget stimuli at Fz and the change of din the CPT-X were negatively correlatedp0.05, and the change of P2 amplitude to target stimuli at Pz and din the CPT-AX were positively correlatedp0.05. ConclusionMPH improves change orienting reaction, the delivery of task relevant information, accuracy and perceptual sensitivity in ADHD. And the increase of ability to discriminate targets from non-targets reflects reduced evaluation time in large memory component task and enhanced change orienting reaction in simple task. KEY WORDSAttention-deficithyperactivity disorder Event-related potentials Continuous performance test Methylphenidate. 286

Table 1. The variables of T.O.V.A. inattention impulsivity disinhibition variability inconsistency 200msec., 291

Table 1. The variables of T.O.V.A. inattention impulsivity disinhibition variability inconsistency 200msec., 291 KISEP Original Articles 11 2 2000 Korean J Child & Adol Psychiatr 11290~296 주의산만을주소로소아정신과를내원한 아동의인지적특성 - T.O.V.A. 양상을중심으로 - T.O.V.A. PROFILES OF CLINICALLY REFERRED CHILDREN WITH SYMPTOMS OF INATTENTION