< 학술연구용역사업최종보고서 > 지역사회정신건강고위험군아동청소년추적관리코호트확대 (The follow-up and management system for children and adolescents at high-risk of mental health dwelling in community)
1) 2013-14. 2) ) : 1 2 3 SNS ) : 1 2013-14 68 2 18~18 60. - 1,, - - 1, - -
3) ) 2013-14 - 9 68 3, 1 11 68 24(35.3%). -, 9(37.5%), 6(25%), 9(25%) 2014. -. ) -, 18~6 80 SNS 60 CBCL 1, 57. -. - 57 16(28.07%). - SNS, 1:1. - ) - 9 230, 169(70%)
- 169 CES-D 76(45%), SIQ 45(26.6%), SDQ 9(5.3%), 36(21.3%), 45(26.6%), 21(12.4%). -, ADHD 267 68(25.5%). - 2, 10 CCTT 2(20%), Stroop 7(70%), ATA 9(90%), WCST 3(30%), KEDI-WISC 4) -. -,.,.,,,.
1) Objectives The purpose of this study was to expand the cohort established by the 2013-2014 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 2013-2014 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
3) Study results ) Follow up of 2013-2014 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 2014. - 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.
- 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.
,,. 2013 534 8.98%, 8.98%, 10~15%,,,..,
.. (, 2009).,. 8~10% 2005 2,672 ( 1,645, 649, 378) -(attention deficit hyperactivity disorder, ADHD) 13.3%, 23%, 7.4%, 1 26%.,.,.,,.,,,,., 2011 ADHD 300.,.
14 48 76.3%(29). 2005 28%,. 14,.,.
(CAT) 1 - (STAI) 2 CoA 3 (K-LDES) 1 2 (K-CBCL) 3 ADHD (K-ARS)
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)
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)
1) 2), SNS 1) SNS 2) 3 3) 6 4) 1:1 SNS 1) 404 SNS 173, 18 ~6 140 CBCL 1. 88 1
57. 2) 9 7~ 18 288, 147. 3) 2013-14 68 26 3, 15 15 11.
KM-CHAT (Korean Modified Checklist for Autism in Toddlers) CBCL 1.5-5 Beck Depression Inventory-II (BDI-II) CBCL 1.5-5 Beck Depression Inventory-II (BDI-II) ADHD (Korean ADHD Rating Scale, K-ARS) CBCL 6-18 Beck Depression Inventory-II (BDI-II)
(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)
.
107 35 5 147 80 30 3 113 ( // /) 27 5 2 34
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)
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 < >, < >.
(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
(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).
2) (Korean Child Behavior Checklist: K-CBCL): Achenbach (1991) (, 1990;, 1996). K-CBCL 2 121 50 10 T-.,,.,, /,,,,,,,,,, 13. 3) ADHD (Korean ADHD Rating Scale-IV: K-ARS): DuPaul(1991) ADHD (, 2002). K-ARS DSM-IV ADHD 18. 0, 1, 2, 3. -. 4) (Disruptive Behavior Disorder Scale according to DSM-IV: DBDS): DSM-IV ADHD, ODD, CD. ADHD 18, ODD 8, CD 15 41. 0, 1, 2, 3.
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, 0 3. 8) (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.
. 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 1 1 15, CCTT 2 1 15,.. 3) Color and Word test/ Stroop:. 3, 45 (W), (C). - (CW). -
., (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):,,,,, 5 6... 1) : Pharis(1978),,,,,,,, 13 5 (Pharis Self Confidence Scale: PSCS)., 11 55,. 2) KM-CHAT(Korean Modified Checklist for Autism in Toddlers)
: KM-CHAT 18 30. 23,, 23 3 6 2 2. 6 (2, 7, 9, 13, 14, 15 ) (Robins et al, 2001). SPSS..,.
36 63.2 () 21 36.8 57 100.0 18 1 1.8 18-23 4 7.0 24-35 17 29.8 36-47 22 38.6 48-59 7 12.3 60-71 6 10.5 57 100.0
1 14 24.6 2 30 52.6 3 6 10.5 4 3 5.3 53 93.0 4 7.0 57 100.0 48(84.2%), 53(92.9%). 13 22.8 10 17.5 35 61.4 43 75.4 7 12.3 3 5.3 55 96.5 56 98.2 2 3.5 1 1.8 57 100.0 57 100.0
., 29(50.9%), 32(56.1%). 1 1.8 0 0 13 22.8 1 1.8 16 28.1 5 8.8 10 17.5 11 19.3 6 10.5 3 5.3 1 1.8 3 5.3 8 14.0 2 3.5 2 3.5 32 56.1 57 100.0 57 100.0
, 19.3%(11) 200-300 56.1%, 17.5%. 1 1.8 5 8.8 32 56.1 10 17.5 4 7.0 52 91.2 5 8.8 57 100.0 100-200 1 1.8 200-300 11 19.3 300-400 3 5.3 400-500 5 8.8 500 3 5.3 23 40.4 34 59.6 57 100.0
-12, 13-24, 25-36 12, 13,,. -12 13-24 25-36 45 78.9 28 49.1 15 26.3 3 5.3 6 10.5 2 3.5 3 5.3 3 5.3 0 0 1 1.8 0 0 0 0 4 7.0 6 10.5 4 7.0 0 11 19.3 28 49.1 0 0 1 1.8 0 0 56 98.2 55 96.5 49 86.0 1 1.8 2 3.5 8 14.0 57 100.0 57 100 57 100
59 (25.7) 64 (24.0) 106 (46.1) 127 (47.6) 65 (28.3) 76 (28.5) 230 267
(%) () 1 (4.2) 106 (54.2) 65 (41.7) 14.96 (2.26) 24 (100) 1, 16. CBCL 1.5-6 T 60-64 : T 64 : T 65-70 : T 70 :
KM-CHAT BDI 1) 3 2) 2, 7, 9, 13, 14, 15 2 16-23 : 24 : 1) 1 16 6, 10. 18-23 2 12.5 24-35 4 25 36-47 6 37.5 48-59 3 18.75 60-71 1 6.25 16 100.0.
() 1 3 4 1 3 4 4 2 6 1 1 2 1 1 2 1 0 1 3 1 4 2 3 5 0 0 0 0 2 2 0 0 0 KM-CHAT 2 0 2 1, 147. CES-D 0~15 : 16~24 : 25 : SIQ 0~5.
SDQ-KR BES K-ARS. 20 : 1) 10,, 40. 2) 17, 16, 20. : 1,2,4,5,7,8,11,13,15,17,18 : 3,6,9,10,12,14,16,19,20 19 17 1)
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 267 68(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(86.4) 87(82.1) 53(81.5) 8(13.6) 19(17.9) 12(18.5) 0.508 0.476 28(47.5) 48(45.3) 39(60.0) 31(52.5) 58(54.7) 26(40.0) 2.058 0.151
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) 0.666 0.414 1.668 0.196 0.821 0.365 2.144 0.143
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18 15 (), 19 17 20 16 21 14 22 12,, () 23 16 24 15
A 21 B 22 C 24 D 7 E 5 F 13 G 6 H 16 I 7
,,,,, 1 2 3 4 5 6 7 4~6 9~12 - - 18~24 18~29 30~36 42~48 42~53 54~60 54~65 66~71 - ( :, : ) -
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