주의산만을 주소로 소아정신과를 내원한 아동의 인지적 특성 : T.O.V.A. 양상을 중심으로

신의진,이수진,이혜란,고려원 대한소아청소년정신의학회 2000 소아청소년정신의학 Vol.11 No.2

본 연구에서는 주의산만을 주소로 내원하는 아동을 진단 준거에 따라 분류하고 각 진단 집단을 설명할 수 있는 인지적 특성을 T.O.V.A. 양상을 중심으로 설명하였다. 소아정신과를 방문한 65명의 아동을 각각 주의력결핍 과잉행동장애(38명), 틱장애(17명), 그리고 기타 정서장애(10명) 집단으로 분류한 후 주의산만의 정도에 영향을 미칠 수 있는 집단의 연령 및 지능(전체 지능, 동작성 지능, 언어성 지능)을 먼저 파악한 후 T.O.V.A.의 중다구인(누락오류, 오경보오류, 정반응시간, 반응시간 표준편차, 예기반응, 다중반응)을 통해 주의산만의 양상을 살펴보았다. 세 집단 간에 연령에서 집단 간에 유의미한 차이가 나타나 연령 수준의 차이에서 기인한 효과를 배제한 결과, 언어성 지능에서 세 집단 간에 유의미한 차이가 나타났다. 또한, T.O.V.A.의 정반응 시간(전반부, 후반부, 전체)에서 세 집단간에 유의미한 차이가 있는 것으로 나타났다. 주의력결핍 과잉행동장애 집단은 틱장애 및 기타 정서장애 집단보다 T.O.V.A.의 정반응 시간이 길어 정보처리의 지연을 시사해 주었다. 한편 주의산만을 주소로 내원하는 아동의 경우 T.O.V.A. 양상과 더불어 연령과 지능의 효과에 대해 신중히 고려해야 할 필요가 있겠다. 중심 단어 : 인지적 특성ㆍ주의산만ㆍT.O.V.A.ㆍ정반응시간ㆍ주의력결핍 과잉행동장애ㆍ틱장애ㆍ기타 정서장애. Objective : This study aims to investigate the cognitive characteristics of clinically referred children with symptoms of inattention, cash as having ADHD, tic disorder, and emotional disorder. Methods : 65 boys(38 with ADHD, 17 with Tic disorder, and 10 with Emotional disorder) were individually assessed using the KEDI-WISC(FIQ, VIQ, PIQ) and T.O.V.A.(errors of omission, errors of commission, reaction time, variability, anticipatory response, multiple response), and the results of those tests were analyzed. Results : There was significant difference among three diagnostic groups of the VIQ of KEDI-WISC and the reaction time of T.O.V.A. after the correction of the effect of age difference. Conclusion : The finding suggest that the reaction time of T.O.V.A. might be the useful variable to differentiate the ADHD from other psychiatric disorders and the effect of age and IQ difference should be considered carefully to diagnose in clinical setting. KEY WORDS : Cognitive characteristicㆍInattentionㆍT.O.V.A.ㆍReaction time.

유아자폐증의 정신병리과 혈소판 혈장 세로토닌 농도와의 상관관계

신의진,민성길 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

We attempted to investigate the abnormalities of serotonergic system in infantile autism, and to find the relationship between the abnormalities of serotonergic system and the psychopathology of infantile autism. In this study, the concentrations of 5-HT in platelet rich plasma(PRP) were compared among autistic, atypically autistic and control groups, and the psychopathology of infantile autism, measured with Childhood Autism, Rating Scale(CARS), was correlated with the concentrations of 5-HT in PRP in autism o? atypical autism group. The subjects of this study were 48 autistic patients, 15 atypically autistic patients and 38 control children and the concentration of 5-HT was measured using HPLC-ECD(High Performance Liquid Chromatography-Electrochemical Detection) method. The results were as follows : 1) The concentration of PRP 5-HT in patients with atypical autism was significantly higher than that of control children, and patients with atypical autism showed the highest level. 2) The concentration of PRP 5-HT was related with 8th CARS item, abnormal auditory responsiveness, in autistic group. But there was no significant correlation in atypically autistic group. 3) Age was not significantly associated with the concentration of PRP 5-HT in autistic, atypically autistic and control groups. 4) The cognitive function(SQ) was not significantly associated with the concentration of PRP 5-HT in autistic and atypically autistic groups. 5) No significant sex difference of PRP 5-HT concentration was found in the autistic, atypically autistic and control groups. These results suggest that both autism and atypical are related with the abnormality of serotonergic system, and the high 5-HT level is related with the symptom of abnormal auditory responsiveness in children with infantile autism.

북한의 기아상태가 소아 정신건강에 미치는 영향

신의진 연세대학교 통일연구원 2000 통일연구 Vol.4 No.1

Starvation of North Korea has been a world wide news for several years.Starvation may have a lot of serious negative impacts on both physical and mental health of North Korean people.In children, the problems might be even more serious, considering starvation's impacts on developing brain and future of the society. This study aims to review topics regarding current children's nutritional status in North Korea, the impacts of malnutrition on the brain development of pre/post natal periods of young children, and relationship between chronic malnutrition and social, emotional, cognitive development of children.We also try to discuss the reason why urgent food supply from other countries is necessary and how we can help them prevent negative complications effectively. We searched MEDLINE by using key words, such as malnutrition, starvation, physical health, brain development, behavioral problems, intelligence. From the collaborative studies of UNICEF, EU, and WFP, more than 60% of children under seven years in North Korea were suffering from severe malnutrition, and the situation was worse in children younger than 3 years.Several studies showed mother's severe malnutrition during early pregnancy was related to mental problems of their children.And also children experiencing chronic under-nutrition reveal to have more problems in cognitive development as well as social and behavioral problems.However, these negative impacts were somewhat reversible if resupply of food - especially protein rich food - was possible. These results suggest the serious malnutrition of children in North Korea might cause many problems in people's mental and physical health in the future.This can bring a lot of social problems and decrease social productivity after reunification of Korean peninsula.However, we can prevent these problems by simply supplying protein-rich food to young children and pregnant women in North Korea.

반응성 애착장애 아동의 애착유형

신의진,이순행,이경숙,전여숙,노경선,민성길 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

This study aims at examining examine the quality of attachment in children with Reactive Attachment Disorder(RAD). The subjects of this study were 26 chidren with RAD and 22 normal children as control group. The diagnosis of RAD was made according to DSM-Ⅳ and ICD-10 criteria of reactive attachment disorder. Attachment of each children was classified by using the Strange Situation Procedure(SSP). The data was statistically processed through Fisher's exact test and t-test. The results were as follows : Among the RAD children, 61.5% were classified as disorganized(D) type, 26.9% as anxious-avoidant(A) type, 11.6% as anxious-avoidant(C) type. Among the normal children, 63.5% were classified as secure attachment(B) type, 18.3% as anxious-avoidant(A) type, 13.6% as anxious-avoidant(C) type, 4.5% as disorganized(D) type. And RAD children had sifnigicantly higher proportion of disorganized(D) type and lower proportion of secure(B) type than that normal children. The above results suggest that RAD children has serious problems in their attachment relationship and there must be some consideration on serious attachment problems to make diagnosis and intervention of RAD children.

반응성애착장애아의 어머니-아동 관계

신의진,이경숙,박숙경 대한소아청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.1

본 연구는 반응성 애착 장애 아동(Reactive Attachment Disorder, 이하 'RAD')의 혼란된 부모-아동 관계를 애착이론의 입장에서 체계적으로 살펴보고자 하였다. 이를 위해 1994년 8월에서 1995년 8월 사이 소아정신과에 내원한 RAD 아동과 어머니 20쌍과 비교집단으로 정상 아동과 어머니 20쌍을 대상으로, 아동에 대한 내적 실행 모델 면접(Working Model of Child Interview, 1986)과 낯선 상황 절차(Strange Situation Procedure, 1978), 부모-아동 상호작용 척도(Dyadic Parent-child Interaction Coding Scales, 1983)을 실시하여 어머니의 아동에 대한 내적 표상과 어머니의 내적 표상 유형과 아동의 애착 유형과의 관계, 내적 표상 유형에 따른 어머니-아동 상호작용 양상을 살펴보았다. 1) 대상 어머니들을 3가지 내적 표상 유형으로 분류해 본 결과, 비교 집단 어머니는 모두 균형된 표상으로 분류되었고 RAD 집단 어머니는 비개입된 표상(55%), 왜곡된 표상(45%)으로 분류되었다. 2) 어머니의 아동에 대한 내적 표상 유형은 아동의 애착 유형과 체계적으로 연관되었다. 균형된 표상의 어머니의 아동은 모두 안정 애착이었고 비개입된 표상 어머니의 82%는 그 아동이 불안/회피 애착으로 분류되었고 왜곡된 표상 어머니는 56%가 그 아동이 비조직/비일관 애착, 33%는 불안/저항 애착으로 분류되었다. 3) 어머니-아동 상호작용에서, 비개입된 표상의 어머니는 아동 중심 놀이에서 균형된 표상의 어머니에 비해 묘사적 진술, 반영적 진술, 묘사/반영적 질문을 적게 사용하였고 왜곡된 표상의 어머니는 균형된 표상의 어머니에 비해 직접 명령과 간접 명령을 많이 사용하였다. 장난감 정리하기 과제에서 비개입된 표상과 왜곡된 표상의 어머니는 균형된 표상의 어머니보다 직접명령, 간접명령을 더 많이 사용하였다. 위의 결과를 통해서 볼 때, 어머니의 아동에 대한 내적 실행 모델은 아동과의 애착 관계와 어머니-아동 상호작용에 중요한 요인으로서 혼란된 어머니-아동 관계를 이해하는데 효율적인 접근을 제공하며 아동에 대한 치료적 개입에 유용한 정보를 제공해 줄 것으로 생각된다. The objective of this study is to understand disordered parent-child relationships of Reactive Attachment Disorder(RAD) systematically through the mother's internal working model of child. In this study, RAD mothers' internal representations of the child were compared with mothers' of control group and association between mothers' representation classifications and children's attachment classifications was examined. Also individual differences in mother-child interaction by mothers' representation classifications was observed. The subjects of this study were 40 2-5 year-old children and their mothers, 20 attachment disordered dyads and 20 normal dyads of control group. Mothers were interviewed using the Working Model of the Child(Zeanah, Benoit & Barton 1986) to classify internal representations of child. Children's attachment patterns were assessed by the Strange Situation Procedure. for observation of mother-child interaction, Each dyad was seen in DPICS devised by Eyberg and Robinson(1983). The results of the study were as follows : 1) Among RAD group, 55% of mothers were classified as disengaged and 45% classified as distorted, while all mothers of control group were classified as balanced. In rating scales, there were significant differences in all 3 representation classifications in Intensity of involvement and Coherence. In Intensity of involvement disengaged representations had the lowest score and distorted representations had the lowest score in Coherence. 2) Mothers' representation classifications were related to children's attachment classifications. All mothers of control group whose children were classified as secure were classified as balanced. Among RAD's mothers, by contrast, 82% of mothers classified as disengaged had children classified as anxious-avoidant, 56% of mothers classified as distorted had children classified as disorganized/disoriented and 33% of mothers classified as distorted had children classified as anxious-resistant. 3) There were individual differences in mother-child interactions by mothers' representation classifications. In the child-centered play, mothers classified as disengaged used discriptive statement, reflective statement and discriptive-reflective question less than balanced mothers. Mothers classified as distorted used direct command and indirect command more than balanced mothers. In the clean-up task, mothers classified as disengaged and distorted used direct command and indirect command more than balanced mothers. The results of this study suggest that parents' working model of the child is an important factor to understand parent-child attachment relationships and their interactions. The understanding of parents' working model of the child is thought to enrich our understanding of disordered parent-child relationships and to provide useful informations for specific and successful treatments.

"한국판 학령전기 기질성격검사[K-psTCI]" 의 신뢰도 및 타당도 검사

박진균,김지웅,기선완,신의진 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

Objectives : The purpose of this study was to evaluate the reliability and validity of the Korean version of Preschool Temperament and Character Inventory (K-psTCI), a questionnaire based on Cloninger's seven-factor model of personality. Methods : The psTCI was translated into Korean and administered to 266 children aged 2-6 years. α test-retest study of the K-psTCI was conducted across a 4-month interval, Internal consistency was calculated by Cronbach a. Test-retest and reliability was analyzed by Pearson correlation analysis. Factor analyses for the temperament and character dimensions were performed using principal component analysis, rotating factors by varimax. The psTCI scores of Korean and United States preschoolers were compared Results : Cronbach α values for the K-psTCI scales ranged from .62 to .78 for each dimensions. Test-retest correlations (r) ranged from .50 to .77 for each dimensions. Explorative factor analysis with the condition of eigenvalue greater than 2 produced four factors for the temperament items and three factors for the character items like the US original version of psTCI. Through factor analyses, five items in the K-psTCI were categorized differently from the US version of psTCI. Korean preschoolers had higher mean scores on Cooperativeness (CO) in males as compared to a sample of US preschoolers. Conclusion : The results of this study suggests that the Korean preschool TCI is satisfactory in reliability and validity.

학령전기 아동의 심적 표상 : ASSOCIATION WITH PARENTAL MENTAL REPRESENTATION 부모에 대한 심적 표상과의 관계를 중심으로

이혜란,신의진,이경숙 대한소아ㆍ청소년정신의학회 1999 소아청소년정신의학 Vol.10 No.1

자폐아동의 애착 안정성

김상원,신의진,이경숙 대한소아ㆍ청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.2

학령기 아동들의 부모에 대한 애착관계가 거부민감성 및 또래 관계에 미치는 영향

이경숙,서수정,신의진 대한소아청소년정신의학회 2000 소아청소년정신의학 Vol.11 No.1

요약 : 본 연구는 영유아기에 부모와의 애착에서 형성된 내적작동모델의 안정성과 불안정성이 학령기에 들어서 아동들이 사회적 상황에서 경험하는 타인들의 거부에 대한 민감성, 또래 관계에서의 수용, 거부와 관련이 있는가를 알아보고자 하였다. 연구 대상은 초등학교 5, 6학년 아동 218명이었으며, 측정도구로는 부모와의 애착 관계 측정도구, 거부민감성 질문지, 또래 관계 사회측정법이 사용되었다. 연구결과 부모와 안정적인 애착 관계를 형성한 아동들은 거부민감성의 하위척도인 불안, 분노, 신념, 심리적반응 모두에서 부모와 불안정한 애착 관계를 형성한 아동에 비해 낮게 나타났다. 또한 또래 관계에서 수용되는 아동들은 거부당하는 아동들보다 부모와의 애착 관계 척도에서 점수가 더 높은 것으로 나타났다. 본 연구 결과는 부모와 불안정한 애착 관계를 형성한 아동들은 거부민감성이 증가하여 타인과의 관계에서 자신이 거부당했다고 더 쉽게 지각하고 불안과 분노를 더 느끼고 과잉 반응함으로써 심리적 안정감이 감소되는 것으로 나타났다 또한 부모와 형성한 안정적인 애착 관계는 대인관계에 대한 긍정적 경험을 제공함으로써 아동 자신에 대한 긍정적인 관점을 갖게 되고 따라서 또래로부터 긍정적인 반응을 이끌어내어 실제 대인 관계에서 수용되는 것으로 생각된다. This study aims to reveal whether attachment relationship with parents can differ from children being accepted and rejected in peer relations, and whether children's rejection sensitivity can differ from children having secure and insecure attachment relationship with parents. Subjects were 218 students in fifth and sixth grade of primary school. Inventory of Parent and Peer Attachment(IPPA), Children's Rejection Sensitivity Questionnaire(CRSQ, and peer relation sociometrics were used as measurements. The results showed that children in secure attachment with parents had lower scores on the subscales of CRSQ, such as anxiety, anger, belief, and psychological reaction, than children in insure attachment relationship with parents. And IPPA scores were higher in children being accepted in peer relation than children being rejected. These results can be considered that early attachment relationship with parents may influence children's rejection sensitivity and peer relation. KEY WORBS : School-age children · Parents · Attachment relationship Internal working model · Rejection sensitivity Peer relation.

야뇨증 환아들의 심리사회적 특성에 대한 다기관 연구 : 행동 및 정서 문제를 중심으로

조수철,김재원,신민섭,황준원,한상원,박관현,이상돈,김경도,김건석,서홍진,이유식,정재용,김영균,문두건,남궁미경,한창희,조원열,김영식,배기수,이종국,정우영,신의진 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.6

Objectives : The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. Methods : Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. Results : Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. Conclusion : The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.