KISEP Original Article J Korean Neuropsychiatr Assoc Vol 45, No 1 주의력결핍과잉행동장애환아들의기질및성격특성 장원석 홍성도 정유숙 Temperament and Character Patterns of Patients with Attention Deficit Hyperactivity Disorder Won Seok Jang, MD, Sungdo D Hong, MD and Yoosook Joung, MD, PhD Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Objectives:The purpose of this study is to compare temperament/character patterns of patients with attention deficit hyperactivity disorders with normal controls. Methods:The Junior Temperament and Character Inventory was given to a clinical sample of one hundred - four patients with ADHD (all male, mean age 10.46±1.45) and their parents. The diagnoses were done using DSM-IV criteria. Fifty ones of the patients with ADHD were confirmed by K-SADS-PL-K. One hundred forty four normal controls (all male, mean age 13.26±0.26) and their parents were enrolled to compare temperament and character patterns with ADHD patients. Results:Novelty seeking was significantly higher in parental JTCI of patients with ADHD. Reward dependence, persistence, self directedness, cooperativeness and self transcendence (ST23) were significantly lower in both self and parental JTCI of patients with ADHD. Using K-SADS-PL-K, ADHD patients were divided into three groups with their ADHD subtype (combined type:32, inattentive type:11, NOS type:7). Self transcendence (ST23) in self JTCI was significantly lower in ADHD patients of the inattentive type than those of the combined type. Conclusion:The temperament and character patterns of ADHD patients were different from those of normal controls. Novelty seeking was significantly higher in the ADHD patients. Reward dependence, persistence, self directedness, cooperativeness, self transcendence (ST23) were significantly lower in the ADHD patients. (J Korean Neuropsychiatr Assoc 2006; 45(1):77-82) KEY WORDS:Temperament ADHD JTCI. 서 론 - 77
방법 연구대상 측정도구 아동용기질성격검사 (Junior temperament and character inventory) - K-SADS-PL-K(Korean Kiddie-Schedule for Affective Disorders and Schizophrenia -Present and Lifetime Version-Korean Version) 통계분석 결과 78
Table 1. Temperament and character patterns of subjects self rating scale Scale ADHD No MeanSD NC No MeanSD Significance* NS 95 08.293.20 137 08.012.72 0.47* HA 95 10.494.28 137 09.934.53 0.34* RD 95 07.282.61 137 08.712.43 0.00* SD 95 10.223.18 136 11.812.80 0.00* C 95 11.873.44 134 13.903.08 0.00* ST1 95 01.551.48 144 01.551.31 0.99* ST23 95 02.471.57 139 02.951.45 0.02* NCnormal controls, NSnovelty seeking, HAharm avoidance, RDreward dependence, SDself directedness, Ccooperativeness, STself transcendence, independent t test Table 2. Temperament and character patterns of subjects parent rating scale Scale ADHD No MeanSD NC No MeanSD Significance* NS 104 10.183.26 129 08.293.31 0.00* HA 104 09.294.48 125 10.033.83 0.18* RD 104 04.492.30 130 05.142.10 0.00* PS 104 00.881.04 130 01.941.46 0.00* SD 104 07.763.60 128 11.723.98 0.00* C 104 11.634.03 126 14.372.91 0.00* ST1 104 01.081.10 131 01.210.99 0.31* ST23 104 01.321.17 127 01.841.30 0.00* NCnormal controls, NSnovelty seeking, HAharm avoidance, RDreward dependence, PSpersistence, SDself directedness, Ccooperativeness, STself transcendence, independent t test 고찰 - 79
Table 3. Temperament and character patterns of subjects stratified by subtype of ADHD Scale Combined type n32 Inattentive type n11 NOS n7 df P value Self rating NS 22.77 24.00 18.75 2.72 HA 21.64 21.55 28.08 2.52 RD 21.16 26.75 21.67 2.48 SD 21.52 24.40 23.92 2.46 C 21.82 24.40 22.50 2.30 ST1 22.63 23.45 20.33 2.24 ST23 25.71 12.65 23.92 2 *.02* Parent rating NS 24.92 24.91 29.07 2.78 HA 24.02 24.82 33.36 2.30 RD 23.45 30.27 27.36 2.37 PS 26.73 25.00 20.64 2.55 SD 23.34 29.82 28.57 2.37 C 23.95 30.23 25.14 2.47 ST1 25.98 26.59 21.57 2.71 ST23 25.92 28.68 18.57 2.31 Data are given as mean rank unless otherwise indicated NSnovelty seeking, HAharm avoidance, RDreward dependence, PSpersistence, SDself directedness, Ccooperativeness, STself transcendence, NOSnot otherwise specified, Kruskal Wallis test - 80
결 중심단어 REFERENCES 1) Barkley RA. A critique of current diagnostic criteria for attention deficit hyperactivity disorder: clinical and research implications. J Dev Behav Pediatr 1990;11:343-352. 2) APA. Diagnostic and Statistical Manual for Mental Disorders. 4th ed. Washington D.C. American Psychiatric Association Press;1994. 3) Szatmari P, Offord DR. Correlates, associated impairments and patterns of service utilization of children with attention deficit disorder: finding from the Ontario Child Health Study. J Child Psychol Psychiatry 1989;30:205-217. 4) 조수철, 신윤오. 파탄적행동장애의유병률에대한연구. 소아청소년정신의학 1991;41:141-149. 5) 홍강의, 오경자. 소아정신과와소아과외래환자의과잉행동에관한연구. 최신정신의학 1980;23:51-57. 6) Shastry BS. Molecular genetics of attention-deficit hyperactivity disorder (ADHD): an update. Neurochem Int 2004;44:469-474. 론 81
7) Bates. Concepts and measurement of temperament: in Kohnstamm GA, Bates JE, Rothbart MK (eds): Temperament in Childhood. Chichester Wiley & Sons;1989. p.3-26. 8) Goldsmith HH, Buss AH, Plomin R, MK R. What is temperament? Four approaches. Child Dev 1987;58:505-527. 9) Goldsmith HH, Gottesman II. Origins of variation in behavioral style: a longitudinal study of temperament in young twins. Child Dev 1981; 52:91-103. 10) Comings DE, Gade-Andavolu R, Gonzalez N, Wu S, Muhleman D, Blake H, et al. A multivariate analysis of 59 candidate genes in personality traits: the temperament and character inventory. Clin Genet 2000;58:375-385. 11) Cloninger CR, Przybeck TR, Svrakic DM. The temperament and character inventory (TCI): a guide to its development and use. Washinton Univ, St Louis; Missouri: Center for psychobiology of personality;1994. 12) Luby JL, Svrakic DM, McCallum K, Przybeck TR, Cloninger CR. The Junior Temperament and Character Inventory: preliminary validation of a child self-report measure. Psychol Rep 1999;84:1127-1138. 13) Lyoo IK, Han CH, Lee SJ, Yune SK, Ha JH, Chung SJ, et al. The reliability and validity of the junior temperament and character inventory. Compr Psychiatry 2004;45:121-128. 14) Kim YS, Cheon KA, Kim BN, Chang SA, Yoo HJ, Kim JW, et al. The reliability and validity of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version- Korean version (K-SADS-PL-K). Yonsei Med J 2004;45:81-89. 15) 박병관. 학습능력검사. 한국심리검사연구소 ;2000. 16) 소유경, 노주선, 김영신, 고선규, 고윤주. 한국어판부모교사 ADHD 평가척도의신뢰도와타당도연구. 신경정신의학 2002; 41:283-289. 17) Thomas A, Chess S. Temperament and development;1977. 18) Rutter M. Temperament, Personality and Personality Disorders. Br J Psychiatry 1987;150:443-458. 19) Strelau J. Temperament: a psychological perspective. New York: Plenum Press;1998. 20) Cloninger CR. A systematic method for clinical description and classification of personality. Arch Gen Psychiatry 1987;44:573-588. 21) Cloninger CR, Svarakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993;50:975-990. 22) Ebstein RP, Novick O, Umansky R, Priel B, Osher Y, Blaine D, et al. Dopamine D4 receptor exon III polymorphism associated with the human personality trait of Novelty seeking. Nat Genet 1996;12:78-80. 23) Benjamin J, Li L, Patterson C, Greenberg BD, Murphy DL, Hamer DA. Populational and familial association between the D4 dopamine receptor gene and measure of Novelty seeking. Nat Genet 1996;12: 81-84. 24) Bussing R, Gary FA, Mason DM, Leon CE, Sinha K, Garvan CW. Child temperament, ADHD, and caregiver strain: exploring relationships in an epidemiological sample. J Am Acad Child Adolesc Psychiatry 2003;42:184-192. 25) Tillman R, Geller B, Craney JL, Bolhofner K, Williams M, Zimerman B, et al. Temperament and character factors in a prepubertal and early adolescent bipolar disorder phenotype compared to attention deficit hyperactive and normal controls. J Child Adolesc Psychopharmacol 2003;13:531-543. 26) Eddy LS, Toro TJ, Salamero BM, Castro FJ, Cruz Hernandez M. Attention deficit hyperactivity disorder. A survey to evaluate risk factors, associated factors and parental child rearing behavior. An Esp Pediatr 1999;50:145-150. 27) 조수철, 김동현, 김자성. 주의력결핍과잉운동장애아의기질적특성. 소아청소년정신의학 1993;4:114-123. 28) Herbst JH, Zonderman AB, McCrae RR, Costa PT Jr. Do the dimensions of the Temperament and Character Inventory map a simple genetic architecture? Evidence from molecular genetics and factor analysis. Am J Psychiatry 2000;157:1285-1290. 82