Cognitive and Behavioral Outcomes of School-aged Children Born Extremely Preterm: a Korean Single-center Study with Long-term Follow-up

Kim Eun Sun,Kim Ee-Kyung,Kim Sae Yun,Song In Gyu,Jung Young Hwa,Shin Seung Han,Kim Han-Suk,Kim Johanna Inhyang,Kim Bung Nyun,Shin Min-Sup 대한의학회 2021 Journal of Korean medical science Vol.36 No.39

Background: School-aged children born very preterm have been suggested to have worse cognitive and behavioral outcomes than children born full-term. Executive function (EF) is a higher level of cognitive function related to academic achievement. The present study aimed to evaluate the cognitive (including EF) and behavioral outcomes of Korean children born extremely preterm (EP) and to analyze any biological or socioeconomic risk factors for poor cognitive outcomes in this population. Methods: A total of 71 infants weighing < 1,000 g at birth or born before 30 weeks of gestation (EP group) who were admitted to the neonatal intensive care unit from 2008 to 2009 were included in this study and compared with 40 term-birth controls. The Korean Wechsler Intelligence Scale for Children-Fourth Edition, Advanced Test of Attention (ATA), Stroop test, Children's Color Trails Test (CCTT), and Wisconsin Card Sorting Test (WCST) were used. Additionally, the Korean Child Behavior Checklist (K-CBCL) and Korean ADHD Rating Scale (K-ARS) were completed. Perinatal and demographic data were collected and analyzed. Results: The mean full-scale intelligence quotient (FSIQ) score in the EP group was significantly lower than that of the term control group (89.1 ± 18.3 vs. 107.1 ± 12.7; P < 0.001). In the EP group, 26 (37%) children had an FSIQ score below 85, compared to only one child (3%) in the control group. Furthermore, the EP group showed significantly worse EF test results (ATA, Stroop test, CCTT, WCST). Except for the higher social immaturity subscore in the EP group, the K-CBCL and K-ARS scores were not different between the two groups. EP children who received laser treatment for retinopathy of prematurity (ROP) had an 8.8-fold increased risk of a low FSIQ score, and a 1-point increase in the discharge weight Z-score decreased the risk of a low FSIQ score by approximately half in this EP cohort. Conclusion: This is the first Korean study to investigate the cognitive and behavioral outcomes of school-aged children born EP. In the study cohort, EP children exhibited significantly lower FSIQ scores and EF than their full-term peers, and 37% of them had cognitive problems. Nonetheless, except for social immaturity, the behavioral problems were not different in EP children. Severe ROP and low discharge weight Z-score were identified as independent risk factors for low FSIQ score after adjusting for birth weight.

Interaction between <i>DRD2</i> and lead exposure on the cortical thickness of the frontal lobe in youth with attention-deficit/hyperactivity disorder

Kim, Johanna Inhyang,Kim, Jae-Won,Lee, Jong-Min,Yun, Hyuk Jin,Sohn, Chul-ho,Shin, Min-Sup,Kim, Bongseog,Chae, Jonghee,Roh, Jaewoo,Kim, Bung-Nyun Elsevier 2018 Progress in neuro-psychopharmacology & biological Vol.82 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>The dopamine receptor D2 receptor (<I>DRD2</I>) gene and lead exposure are both thought to contribute to the pathophysiology of attention-deficit/hyperactivity disorder (ADHD). ADHD is characterized by delay in brain maturation, most prominent in the prefrontal cortex (PFC). The D2 receptor is also mainly located in the PFC, and animal studies show that lead exposure affects the dopaminergic system of the frontal lobe, indicating an overlap in neural correlates of ADHD, <I>DRD2</I>, and lead exposure. We examined the interaction effects of <I>DRD2</I> rs1800497 and lead exposure on the cortical thickness of the frontal lobe in patients with ADHD.</P> <P><B>Methods</B></P> <P>A 1:1 age- and gender-matched sample of 75 participants with ADHD and 75 healthy participants was included in the analysis. The interaction effects of <I>DRD2</I> and lead exposure on the cortical thickness of 12 regions of interest in the frontal lobe were examined by multivariable linear regression analyses.</P> <P><B>Results</B></P> <P>When we investigated the <I>DRD2</I> ×lead effects in the ADHD and HC groups separately, significant <I>DRD2</I> ×lead effects were found in the ADHD group, but not in the healthy control group in multiple ROIs of the frontal lobe. There was a significant negative correlation between the cortical thickness of the right superior frontal gyrus and inattention scores.</P> <P><B>Conclusions</B></P> <P>The present findings demonstrated significant interaction effects of <I>DRD2</I> and lead exposure on the cortical thickness of the frontal lobe in ADHD. Replication studies with larger sample sizes, using a prospective design, are warranted to confirm these findings.</P> <P><B>Highlights</B></P> <P> <UL> <LI> The dopamine receptor D2 receptor (<I>DRD2</I>) gene and lead exposure contribute to the pathophysiology of ADHD. </LI> <LI> Previous study results indicate an overlap in the neural correlates of ADHD, <I>DRD2</I>, and lead exposure in the prefrontal cortex. </LI> <LI> We found significant interactions between <I>DRD2</I> and lead exposure on the cortical thickness of the frontal lobe in ADHD patients. </LI> <LI> This study highlights the need for consideration of gene-environment interaction when conducting studies regarding dopamine-related genes. </LI> </UL> </P>

The effects of maternal and children phthalate exposure on the neurocognitive function of 6-year-old children

Kim, Johanna Inhyang,Hong, Yun-Chul,Shin, Choong Ho,Lee, Young Ah,Lim, Youn-Hee,Kim, Bung-Nyun Academic Press 2017 Environmental research Vol.156 No.-

<P><B>Abstract</B></P> <P>The primary purpose of this study was to investigate the effects of phthalate exposure on the intelligence and attentional performance of 6-year old children when adjusting each other as covariates. We also investigated the differential effects of phthalate exposure on the intelligence and attention according to exposure period (maternal or children). Urine concentrations of mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-n-butyl phthalate (MBP) were analyzed. Multivariable linear regression models were used to investigate the relationship between exposure to various phthalates with IQ scores and continuous performance test (CPT) variables. There were robust associations between child MEHHP and MEOHP levels with full scale IQ (FSIQ) even after adjusting for demographic variables and CPT scores (MEHHP −9.27, 95% CI: −17.25, −1.29; MEOHP −9.83, 95% CI: −17.44, −2.21). Child MEHHP and MEHOP levels negatively affected omission errors (MEHHP −20.36, 95% CI: −34.17, −6.55; MEOHP −18.93, 95% CI: −32.58, −5.28) and the response time variability (MEHHP −21.07, 95% CI: −39.04, −3.10; MEOHP −20.41, 95% CI −38.14, −2.69) of the CPT after adjusting for demographic variables and IQ. Maternal phthalate exposure had no effects on IQ or CPT variables. These results suggest that children phthalate exposure, but not maternal exposure, has an adverse effect on IQ and attentional performance, and these associations were found to be independent of each other.</P> <P><B>Highlights</B></P> <P> <UL> <LI> The negative effects of phthalate exposure on attention and intelligence in school-age children are independent of each other. </LI> <LI> Childhood, but not maternal phthalate exposure was found to affect both attention and intelligence. </LI> <LI> Phthalate metabolites have a significant association with inattention and deficit in sustained attention. </LI> </UL> </P>

The Effect of Prenatal Cadmium Exposure on Attention-deficit/Hyperactivity Disorder in 6-Year-old Children in Korea

Kim, Woosung,Jang, Yoonyoung,Lim, Youn-Hee,Kim, Bung-Nyun,Shin, Choong Ho,Lee, Young Ah,Kim, Johanna Inhyang,Hong, Yun-Chul The Korean Society for Preventive Medicine 2020 예방의학회지 Vol.53 No.1

Objectives: Prenatal cadmium (Cd) exposure may be associated with attention-deficit/hyperactivity disorder (ADHD) in children. Therefore, the objective of this study was to examine the relationship between Cd exposure during gestation and ADHD at 6 years of age. Methods: As part of an ongoing cohort study (the Environment and Development of Children study), 479 mother-child pairs from Seoul, Korea were included for analysis between 2008 and 2011. The whole blood concentration of Cd was analyzed using atomic absorption spectrophotometry. The parents were surveyed about ADHD behaviors in their children at age 6. Multivariable linear regression models were used to investigate the relationship between prenatal exposure to Cd and ADHD at 6 years of age. Results: Increased prenatal Cd concentrations were associated with increased scores for ADHD for girls, but not for boys, at age 6. A 2-fold increase in the prenatal Cd level was significantly associated with a 22.3% (95% confidence interval, 11.6 to 34.1) increase in ADHD in girls at 6 years of age, as indicated by the linear regression model. Conclusions: Our results identified significant associations between prenatal Cd exposure and ADHD scores in 6-year-old girls.

Resting-state functional magnetic resonance imaging investigation of the neural correlates of cognitive-behavioral therapy for externalizing behavior problems in adolescent bullies

Kim, Johanna Inhyang,Kang, Yun-Hyong,Lee, Jong-Min,Cha, Jungho,Park, Yeong-Hun,Kweon, Kuk-Ju,Kim, Bung-Nyun Elsevier 2018 Progress in neuro-psychopharmacology & biological Vol.86 No.-

<P><B>Abstract</B></P> <P>The purpose of this study was to investigate the neural correlates of cognitive-behavioral therapy (CBT) for externalizing behavior problems in perpetrators of school bullying using assessments of brain activity and behavior. Twenty-five adolescent bullies participated in an 8-session intervention. Prior to and after participation, 24 adolescents were evaluated using the Child Behavior Checklist (CBCL) and 23 completed resting-state functional magnetic resonance imaging. Changes in the fractional amplitude of low-frequency fluctuations (fALFF) and scores on the CBCL were analyzed. We also compared the identified changes into 2 groups (low and high delinquency) differentiated by a cutoff of 65 points on the delinquency subscale of the CBCL. Following the intervention, participants exhibited improvement in the subscores of the CBCL and decreases in the fALFF of the inferior parietal lobule, lingual, interior frontal and middle occipital gyrus. A positive correlation was observed between changes in the CBCL externalizing behavior scores and fALFF of the inferior frontal gyrus. The high delinquency group showed a greater decrease in delinquency and externalizing CBCL subscores across time than did the low delinquency group. The high delinquency group had more areas that showed change in fALFF post-intervention than did the low delinquency group. A positive correlation was observed between changes in the CBCL delinquency scores and fALFF of the precentral gyrus in the high delinquency group. The results indicate that this CBT for externalizing behavior problems in bullies had more positive effects on delinquent behavior in adolescents with high levels of delinquency, and these changes were associated with functional changes in brain activity.</P> <P>Trial registration: ClinicalTrials.gov identifier: NCT02670876 </P> <P><B>Highlights</B></P> <P> <UL> <LI> School bullying is a universal phenomenon that has significant negative effects on mental health for both the perpetrator and victim. </LI> <LI> We conducted cognitive-behavioral therapy targeting cognitive distortions related to externalizing problems commonly found in bullies. </LI> <LI> The purpose of this study was to investigate the effects and neural correlates of this intervention on externalizing problems. </LI> <LI> We found a positive effect on externalizing problems and this was associated with changes in spontaneous neural activity in related brain regions. </LI> <LI> Further studies that include large homogeneous samples and well-controlled designs are warranted. </LI> </UL> </P>

The Effect of Prenatal Cadmium Exposure on Attention-deficit/Hyperactivity Disorder in 6-Year-old Children in Korea

Woosung Kim,Yoonyoung Jang,Youn-Hee Lim,Bung-Nyun Kim,Choong Ho Shin,Young Ah Lee,Johanna Inhyang Kim,Yun-chul Hong 대한예방의학회 2020 Journal of Preventive Medicine and Public Health Vol.53 No.1

Prenatal cadmium (Cd) exposure may be associated with attention-deficit/hyperactivity disorder (ADHD) in children. Therefore, the objective of this study was to examine the relationship between Cd exposure during gestation and ADHD at 6 years of age.

Autism Spectrum Disorder and Behavioral Intervention

Hae-Ah Park,Johanna Inhyang Kim,Yeni Kim,Subin Park,Younghui Yang,Youngsun Lee,Hyojung Lee,Soo Yeon Kim,Bung-Nyun Kim 대한소아청소년정신의학회 2015 소아청소년정신의학 Vol.26 No.2

Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by impaired social communication and repetitive, restricted behaviors and activities. The prevalence of ASD has been increasing for the past 2 decades, but evidence-based therapeutic approaches are lacking for patients with ASD. To date, there is no cure for the core symptoms of ASD, and the existing treatments focus on improving the patient’s function and adaptation by using behavioral intervention methods. Behavioral interventions have been proven to show the greatest effect when applied before the age of 2 years, for at least 40?60 hours per week. Many clinicians and ASD families are unfamiliar with the treatment methods, and consequently, may seek unproven and potentially hazardous methods. The purpose of this article was to present an extensive and updated review on evidence-based ASD behavioral interventions that are commonly used in clinical settings.

Autism Spectrum Disorder and Behavioral Intervention : An Updated Review

Park, Hae-Ah,Kim, Johanna Inhyang,Kim, Yeni,Park, Subin,Yang, Younghui,Lee, Youngsun,Lee, Hyojung,Kim, Soo Yeon,Kim, Bung-Nyun Korean Academy of Child and Adolescent Psychiatry 2015 소아청소년정신의학 Vol.26 No.2

Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by impaired social communication and repetitive, restricted behaviors and activities. The prevalence of ASD has been increasing for the past 2 decades, but evidence-based therapeutic approaches are lacking for patients with ASD. To date, there is no cure for the core symptoms of ASD, and the existing treatments focus on improving the patient's function and adaptation by using behavioral intervention methods. Behavioral interventions have been proven to show the greatest effect when applied before the age of 2 years, for at least 40-60 hours per week. Many clinicians and ASD families are unfamiliar with the treatment methods, and consequently, may seek unproven and potentially hazardous methods. The purpose of this article was to present an extensive and updated review on evidence-based ASD behavioral interventions that are commonly used in clinical settings.

문화예술교육이 아동의 정서, 행동, 사회성 및인지기능에 미치는 영향

정효석(Hyo Seok Jeong),김경민(Kyoung-Min Kim),김인향(Johanna Inhyang Kim),박수빈(Subin Park),백령(Young Baik),김준원(Jun Won Kim),최재원(Jae-Won Choi),김수연(Soo Yeon Kim),노재우(Jaewoo Roh),이정(Jung Lee),김붕년(Bung-Nyun Kim) 대한사회정신의학회 2017 사회정신의학 Vol.22 No.2

연구목적 : 문화예술교육이 아동의 정서, 행동, 사회성 및 인지기능에 긍정적인 영향을 줄 수 있다는 연구들이 있었으나, 정상 아동군에서 객관적인 신경심리 검사를 통해 이런 긍정적인 영향을 검증한 연구는 많지 않았다. 본 연구는 정상 아동군의 정서, 행동, 사회성 및인지기능에 문화예술교육이 미치는 효과를 보고자 하였다. 방 법 : 초등학교 4학년 학생 30명은 매주 일회씩 11세션과 추가 2세션으로 구성된 문화예술 교육에 참여하였다. 참가자들은 본 교육에 참가하기 전후에 아동우울척도(Children’s Depression Inventory), 자존감척도(Rosenberg Self Esteem Scale), 파탄적 행동장애척도(Disruptive Behavioral Disorder Scale, 아동행동 체크리스트(Korean Child Behavior Checklist, K-CBCL), 사회기술척도 (Social Skills Improvement System-Rating Scales), 대인관계 반응성 척도(Interpersonal Reactivity Index) 를 시행하였으며, 신경심리검사로 주의력검사(Advanced Test of Attention, ATA), 스트룹 검사(Stroop Test) 및 위스콘신 카드정렬 검사(Wisconsin Card Sorting Test, WCST)를 시행하였다. 결 과 : 참가자들은 교육 참여 전후에 정서, 행동, 사회적 기능 척도의 점수에서는 유의미한 변화를 보이지 않았으나, ATA, Stroop test, WCST등의 신경심리검사에서는 유의미한 인지기능의 개선이 관찰되었다. 결 론 : 본 연구에서는 정서, 인지기능의 어려움이 없는 정상 아동군에서도 문화예술교육이 인지기능 효율성의 증진에 긍정적인 영향을 미쳤음을 확인하였다. 향후에는 본 연구의 결과를 확인하기 위한 통제된 종단연구가 추가적으로 필요하다. Objectives : While previous studies reported that the art and culture education might have positive effects on children’s emotional, behavioral, social and cognitive function, few studies have verified this effect in normal children with objective neurocognitive test. This study aimed to examine the effect of art and culture education on emotional, behavioral, social and cognitive function in children. Methods : Thirty 4 th grade elementary school children participated in the art and culture eduation of 11 weekly sessions and 2 booster sessions. Each participant was assessed with Children’s Depression Inventory, Rosenberg Self Esteem Scale, Disruptive Behavioral Disorder Scale, Korean Child Behavior Checklist, Social Skills Improvement System-Rating Scales, Interpersonal Reactivity Index, Advanced Test of Attention (ATA), Stroop Test and Wisconsin Card Sorting Test (WCST) before and after the intervention. Results : The participant’s scores on the scales for emotional, behavioral and social functions didn’t change significantly. However, scores on ATA, Stroop test and WCST showed significant improvement (p<.05) after the attendance of the education. Conclusion : This study suggests that the art and culture education has a positive effect on cognitive function in normal children. Further longitudinal and controlled studies are needed to confirm our findings.

주의력결핍 과잉행동장애 진단 및 치료

이수민(Sumin Lee),최재원(Jae-Won Choi),김경민(Kyoung-Min Kim),김준원(Jun Won Kim),김수연(Sooyeon Kim),강태웅(Taewoong Kang),김인향(Johanna Inhyang Kim),이영식(Young Sik Lee),김봉석(Bongseog Kim),한덕현(Doug Hyun Han),정재훈(Jae Hoon 대한소아청소년정신의학회 2016 소아청소년정신의학 Vol.27 No.4

Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric conditions. In 2007, the Korean Academy of child and Adolescent Psychiatry developed Korean ADHD practice parameter. Advances in the scientific evidence of ADHD caused practice parameter to be modified and updated. The present guidelines developed by ADHD translational research center summarize current literature for the treatment of ADHD in children and adults. This parameter includes the clinical evaluation for ADHD, comorbid conditions associated with ADHD, clinical feature and course, research on the etiology of the disorder, and psychopharmacological and nonpharmacological treatments for ADHD.