Kyong Mee Chung

A Conceptual Model of Child Psychopathology: Implications for Understanding Attention Deficit Hyperactivity Disorder and Treatment Efficacy

Highlights the desirability of using a theoretical framework for guiding the design and evaluation of therapeutic interventions for children with attention deficit hyperactivity disorder (ADHD). A general conceptual model is introduced and used to evaluate ADHD treatment outcome research. Treatments designed to target the substrate level(pharmacological interventions) result in broad, robust improvement in both core and peripheral areas of functioning. Those targeting hypothesized core features of the disorder (i.e., attention, impulsivity–hyperactivity) produce corresponding improvement in core and peripheral outcome measures with the exception of studies employing cognitive–behavior therapy. Those targeting peripheral features of the disorder effect change only in corresponding peripheral areas of functioning. Implications for clinical practice are discussed, and an alternative conceptual model of ADHD is introduced and compared with existing models.

Internalizing Behavior Problems and Scholastic Achievement in Children: Cognitive and Behavioral Pathways as Mediators of Outcome

Examined a conceptual model in which dual developmental pathways (behavioral and cognitive) are hypothesized to account for the relation among internalizing behavior problems, intelligence, and later scholastic achievement using a cross-sectional sample of 325 children. Classroom behavior and select aspects of cognitive functioning (vigilance, short-term memory) were hypothesized to mediate the relations among internalizing problems, IQ, and long-term scholastic achievement. Hierarchical tests applied to a nested series of models demonstrated that (a) individual differences in measured intelligence among children are associated with variations in classroom performance and cognitive functioning, (b) classroom performance and cognitive functioning make unique contributions to prediction of later achievement over and above the influence of intelligence, (c) anxious/depressive features are correlated but separable constructs, and (d) anxiety/depression and withdrawal contribute to prediction of classroom performance and cognitive functioning over and above the effects of intelligence. Classroom performance and cognitive functioning thus appear to mediate the effects of internalizing behaviors as well as intelligence. Particular attention to the presence and potential impact of social withdrawal on childrens functioning, both alone and concomitant with anxiety/depression, appears warranted during the course of clinical evaluations owing to the strong continuity among these variables.

Upgrading the Science and Technology of Assessment and Diagnosis: Laboratory and Clinic-Based Assessment of Children With ADHD

Reviews the usefulness of clinic-based and laboratory-based instruments and paradigms for diagnosing attention deficit hyperactivity disorder (ADHD) and monitoring treatment effects. Extant literature examining the performance of normal children and those with ADHD on an extensive range of neurocognitive tests, tasks, and experimental paradigms indicates that particular types of instruments may be more reliable than others with respect to detecting between-group differences. We review task parameters that may distinguish the more reliable from less reliable instruments. The value of clinic-based and laboratory-based instruments for monitoring treatment response in children with ADHD is questionable when evaluated in the context of ecologically relevant variables such as classroom behavior and academic functioning. We present a general conceptual model to highlight conceptual issues relevant to designing clinic-based and laboratory-based instruments for the purposes of diagnosing and monitoring treatment effects in children with ADHD. Application of the model to currently conceptualized core variables indicates that attention and impulsivity-hyperactivity may represent correlative rather than core features of the disorder. We discuss implications of these findings for designing the next generation of clinic-based and laboratory-based instruments.

Hooked on smartphones: an exploratory study on smartphone overuse among college students

The negative aspects of smartphone overuse on young adults, such as sleep deprivation and attention deficits, are being increasingly recognized recently. This emerging issue motivated us to analyze the usage patterns related to smartphone overuse. We investigate smartphone usage for 95 college students using surveys, logged data, and interviews. We first divide the participants into risk and non-risk groups based on self-reported rating scale for smartphone overuse. We then analyze the usage data to identify between-group usage differences, which ranged from the overall usage patterns to app-specific usage patterns. Compared with the non-risk group, our results show that the risk group has longer usage time per day and different diurnal usage patterns. Also, the risk group users are more susceptible to push notifications, and tend to consume more online content. We characterize the overall relationship between usage features and smartphone overuse using analytic modeling and provide detailed illustrations of problematic usage behaviors based on interview data.

Reduced serum vaspin concentrations in obese children following short-term intensive lifestyle modification

BACKGROUND Recently, visceral adipose tissue-derived serpin (vaspin) was identified as a potential insulin sensitizing adipokine, however, the factors determining the levels of circulating vaspin levels have not been fully understood. We investigated the association between adiposity, insulin resistance, lipid profiles and inflammatory markers including vaspin levels, and the effects of short-term intensive lifestyle modification on circulating vaspin levels in overweight or obese children. METHODS A total of 50 (25 boys, 25 girls) overweight or obese children aged 11 to 13 years (average age: 12.0+/-0.9 y, BMI: 25.35+/-86 kg/m(2)) who complied with inclusion criteria participated in our study. To determine the association between adiposity, insulin resistance, lipid profiles and inflammatory markers including vaspin levels, cross-sectional analyses were performed. Thereafter, subjects underwent a tightly controlled seven-day intensive lifestyle modification including physical activity, dietary modification, and behavioral modification education in residence of a local university dormitory. RESULTS There was a negative correlation between vaspin concentration and fasting insulin (r=-.325, p<0.05) and homeostasis model assessment of insulin resistance (HOMA-IR) (r=-.331, p<0.05) when percent body fat was controlled. Multivariate linear regression analysis found serum vaspin level to be an independent predictor of insulin and HOMA-IR. Short-term intensive lifestyle modification significantly decreased vaspin levels by 39.28% (pre: .84+/-1.0, post: .51+/-1.0 ng/ml, p<0.001) while adiponectin levels increased by 11.2% (pre: 6.50+/-2.89, post: 7.28+/-2.98 ng/ml, p<0.01). In addition, short-term lifestyle modification significantly improved HOMA-IR (pre: 3.58+/-1.93, post 1.30+/-1.9, p<0.001) and lipid profiles. CONCLUSIONS Serum vaspin level is one of the predictors for insulin resistance and was significantly reduced following short-term lifestyle modification.

The association between pentraxin 3 and insulin resistance in obese children at baseline and after physical activity intervention.

BACKGROUND The role of pentraxin-3 (PTX3) in the development of insulin resistance is still not clear. We aimed to test 1) whether circulating PTX3 levels are associated with insulin resistance and 2) whether changes in PTX3 levels after the physical activity are associated with changes in insulin resistance. METHODS Fifty-seven overweight or obese children (39 boys, 18 girls; age: 12.04±0.82y, BMI: 26.5±1.2 kg/m²) participated in the study. All participants were housed together and their amount of physical activity (1823.5±1.34 kcal/day) and food intake (1882±68.8 kcal/day) were tightly controlled. RESULTS Circulating PTX3 levels at baseline were negatively associated with fasting insulin (r=-.336, p=0.012) and homeostasis model assessment of insulin resistance (HOMA-IR) (r=-.334, p=0.014) even after adjustment for BMI and Tanner stage. The degree of change in PTX3 levels notably associated with changes in fasting insulin (r=-.280, p=0.035) and HOMA-IR (r=-.281, p=.034) in response to the physical activity intervention. Subgroup analysis further indicates that HOMA-IR was improved more in subjects whose PTX3 levels were increased compared with subjects who PTX3 levels were decreased (HOMA-IR delta: -2.33±1.3 vs -1.46±0.70, p=0.004). CONCLUSION PTX3 is negatively associated with insulin resistance and associated with changes in insulin resistance induced by physical activity in overweight and obese children.

Cross-cultural differences in comorbid symptoms of children with autism spectrum disorders: An international examination between Israel, South Korea, the United Kingdom and the United States of America

Objective: To examine the relationship between culture and symptoms of comorbid psychopathology in those with autism spectrum disorders (ASD). Design: Multivariate analyses of variance (MANOVAs) for each country and each sub-scale of the Autism Spectrum Disorders-Comorbid for Children (ASD-CC). Follow-up independent univariate analyses and post-hoc tests as needed. Methods: Separate samples from South Korea, the UK and Israel were compared to a sample from the US in order to examine cultural contributions, using the ASD-CC. Results: Overall, few differences were found. Significantly, the US had significantly higher scores than South Korea on the avoidant sub-scale. Additionally, the US had significantly higher scores than Israel on the over-eating and tantrum sub-scales. No significant differences were found between the US and the UK. Conclusion: Cultural factors, such as views of typical behaviour, should be taken into account when examining symptoms of comorbidity in children with ASD.

Posture management program based on theory of planned behavior for adolescents with mild idiopathic scoliosis.

PURPOSE The purpose of this study was to evaluate the effects of a devised posture management program based on the Theory of Planned Behavior in adolescents with mild idiopathic scoliosis. METHODS A quasi-experimental study was conducted. It involved a nonequivalent comparison group design with pretest and posttest. Forty-four female adolescents with mild idiopathic scoliosis participated; data from 35 participants (20 for the test group, 15 for the control group) were used for the final analyses. The devised posture management program ran for 6 weeks. Posture management behavioral determinants (attitude, subjective norms, perceived behavioral control, and behavioral intention) as cognitive outcomes and muscular strength and flexibility as physical outcomes were measured three times: at baseline, week 6 and week 8. Cobbs angle as another physical outcome was measured twice: at baseline and week 8. Descriptive analysis, repeated measures analysis of variance and t test were used for data analyses. RESULTS Attitude, perceived control, and behavioral intention were consistently enhanced by the posture management program. The intervention increased flexibility and muscular strength and decreased Cobbs angle, which reduced spinal curvature. Frequency of posture management exercise showed a gradual increase in the test group. CONCLUSION The results indicate that the posture management program is effective in maintaining posture management behavior in adolescents with mild idiopathic scoliosis for both cognitive and physical outcomes. The posture management program should be helpful in expanding the role of school nurses in improving the health status of adolescents with mild idiopathic scoliosis.

Effectiveness of a College-Level Self-Management Course on Successful Behavior Change

Studies have shown that college-level self-management (SM) courses, which typically require students to complete an individual project as part of the course, can be an effective method for promoting successful self-change (i.e., targeted behavioral change). However, only a handful of studies have focused on and investigated the intensity of the SM component required for successfully changing a target behavior. The purpose of this study was to (a) examine the effectiveness of a SM course in improving a target behavior within a college setting, (b) determine the level of SM course intensity necessary for successful behavioral change, and (c) identify the characteristics of successful self-managers in terms of strategy use. A total of 84 college students were enrolled in a high-intensity SM course, low-intensity SM course, or non-SM course (i.e., control group). Self-report questionnaires were administered at the beginning and end of the courses. Results showed that only the high-intensity SM course was effective for successful behavioral change and helped increase certain psychosocial characteristics (e.g., internal locus of control, expectancy of success). Overall, successful self-managers used significantly more SM strategies than participants who were unable to meet their behavioral goals. Implications and limitations are also discussed.

Cross-Cultural Validation of the Modified Practice Attitudes Scale: Initial Factor Analysis and a New Factor Model.

Objective: The objective of this study was to create the Korean version of the Modified Practice Attitudes Scale (K-MPAS) to measure clinicians’ attitudes toward evidence-based treatments (EBTs) in the Korean mental health system. Method: Using 189 U.S. therapists and 283 members from the Korean mental health system, we examined the reliability and validity of the MPAS scores. We also conducted the first exploratory and confirmatory factor analysis on the MPAS and compared EBT attitudes across U.S. and Korean therapists. Results: Results revealed that the inclusion of both “reversed-worded” and “non–reversed-worded” items introduced significant method effects that compromised the integrity of the one-factor MPAS model. Problems with the one-factor structure were resolved by eliminating the “non–reversed-worded” items. Reliability and validity were adequate among both Korean and U.S. therapists. Korean therapists also reported significantly more negative attitudes toward EBTs on the MPAS than U.S. therapists. Conclusions: The K-MPAS is the first questionnaire designed to measure Korean service providers’ attitudes toward EBTs to help advance the dissemination of EBTs in Korea. The current study also demonstrated the negative impacts that can be introduced by incorporating oppositely worded items into a scale, particularly with respect to factor structure and detecting significant group differences.