INTRODUCTIONTourette syndrome (TS) is a childhood-onset movement disorder entailing vocal tics and multiple motor tics (1). Although the definite pathophysiology of TS is not yet known, there is a hypothesis that the basal ganglia and related thalamocortical circuitry are involved (2, 3).Most of the existing structural neuroimaging studies on TS were on the basal ganglia, corpus callosum, and lateral ventricle (4-10). Functional neuroimaging studies of TS using positron emission tomography (PET) suggest that the cortical system (especially, the frontal lobe area) is related with the pathophysiology of TS (11)(12)(13)(14). However, structural neuroimaging studies of TS on the cerebrum are rare, and a recent regional cerebral volumetric study reported that the broadly distributed cortical systems are involved in the pathophysiology of TS (15). Compared with controls, TS subjects were found to have larger volumes in the dorsal prefrontal regions, and larger volumes in the parieto-occipital regions, but smaller volumes in the inferior occipital regions. Nevertheless, the gray matter and white matter were not segmented in previous cerebral neuroimaging studies, needing studies on whether the pathophysiology of TS is related with the gray matter or the white matter. Previous studies posed many problems related with study methods since they did not control the effect of the disorders that frequently accompany TS including attention-deficit/hyperactivity disorder (ADHD) and obsessivecompulsive disorder (OCD), and various confounding variables including drug-effect, age, sex, and handedness that could affect neuroimaging studies (3).Traditionally, the cerebellum has been viewed as a motor coordination center (16). Studies are also needed on the cerebellum related with TS since TS is basically a movement disorder and abnormality is reported in the cerebellar vermal area in patients with ADHD, which frequently accompany TS (17, 18). However, no neuroimaging study on TS related with the cerebellum has been reported according in the literature.This structural neuroimaging study of segmented regional cerebral and cerebellar volumes tested the following three hypotheses; 1) The segmented cerebral regional volumes (especially, the frontal lobe, parietal lobe, and occipital lobe) J Korean Med Sci 2002; 17: 530-6 ISSN 1011-8934 Copyright � The Korean Academy of Medical Sciences 530The Segmented Regional Volumes of the Cerebrum and Cerebellum in Boys with Tourette SyndromeNeuropathological deficits are an etiological factor in Tourette syndrome (TS), and implicate a network linking the basal ganglia and the cerebrum, not a particular single brain region. In this study, the volumes of 20 cerebral and cerebellar regions and their symmetries were measured in normal boys and TS boys by brain magnetic resonance imaging. Brain magnetic resonance images were obtained prospectively in 19 boys with TS and 17 age-matched normal control boys. Cerebral and cerebellar regions were segmented to gray and white fractions using algorithm for ...

Objective: The purpose of this study was to examine the clinical validities and efficiencies of the Child Behavior Checklist (CBCL) and the ADHD Rating Scale-IV (ARS) in identifying children with attention-deficit hyperactivity disorder (ADHD) in Korean community-based samples.Method: A large sample of elementary school students (n = 1668) participated in this study. We used the CBCL and the ARS as the screening instruments. Diagnoses were determined by clinical psychiatric interviews and confirmed by DSM-IV-based structured interviews.Results: Of the 46 subjects who underwent clinical psychiatric interviews, 33 were diagnosed as having ADHD. A T score of 60 with regard to the Attention Problems profile of the CBCL resulted in a reasonable level of sensitivity or positive predictive value in the diagnosis of ADHD. In both the parent and teacher reports of the ARS, 90th percentile cut-off points resulted in a high level of predictive value. The highest levels of specificity and positive predictive value were obtained when we combined the CBCL (T $ 60 in Attention Problems) and the ARS (parent-teacher total $ 90th percentile) reports. Conclusions:These findings suggest that the combined use of the CBCL and the ARS could serve as a rapid and useful clinical method of predicting or even diagnosing children with ADHD in epidemiologic case definitions. Clinical Implications· A combination of the CBCL and the ARS could serve as a rapid and useful instrument for predicting ADHD. · This study provides a clinically useful guideline for identifying ADHD in community-based samples of developing countries. · There seems to be a lack of understanding in child mental health or child psychiatric disorders in Korea, which must be overcome by developing effective mental health services for children. Limitations· We confined the study to selected samples of an urban community. · The sample size of ADHD was relatively small. · The methods used to combine the reports of different informants need further research.

The results of this study suggest that the comorbidity of alcohol dependence and ADHD in this Korean sample forms a distinct clinical phenotype that shows an increased severity of alcohol-related symptoms and behavioural/emotional problems and that ADHD is associated with an increased risk for the early onset of alcohol dependence in Korean male alcoholics.

ObjectiveThis study was conducted to validate the Advanced Test of Attention (ATA) of the visual attention version of Japanese children with attention deficit/hyperactivity disorder (ADHD) and to evaluate the efficacy of methylphenidate (OROS-MPH) and atomoxetine medications.MethodsTo assess pharmacotherapy efficacy, the visual version of ATA was administered to 42 children with ADHD. Results were assessed using discriminant analysis, ANOVA for indices of ATA before and after medication treatment, and correlation analysis between the improvement of indices of ATA and clinical symptoms during medication treatment.ResultsDiscriminant analysis showed that 69.0% of ADHD children were assigned correctly. The T score of commission errors increased as the trial progressed on the medication-off condition. T scores of commission errors and standard deviation of response times on medication-on condition were low compared to the medication-off condition. A few significant correlations were found between the improvements of indices of ATA and ADHD-Rating Scale (RS) during treatment.ConclusionThe performance of the visual version of ATA on medication-off condition reflected the features of ADHD. Furthermore, the medication treatment effects were confirmed sufficiently. In addition, results suggest that indices of ATA reflected aspects of ADHD symptoms that are difficult to elucidate for ADHD-RS. For assessing symptoms and effects of medical treatment in children with ADHD, ATA might be a useful assessment tool.

This study was undertaken to identify psychiatric morbidity among Korean second and third elementary school children using an objective diagnostic interview tool. Data from 5,118 (2,723 boys, 2,395 girls; mean age = 8.41 years (SD = 0.66)) second and third grade schoolchildren were drawn from 28 elementary schools. After initial screening assessments using the 28-item Child Problem-Behavior Screening Test for parents, 672 primary caregivers were subjected to secondary screening using the Korean version of the CBCL. Two hundred and seventy-one high-risk children selected according to the K-CBCL results, 138 (50.9%) children and their primary caregivers were interviewed using the Korean version of K-SADS-PL for objective DSM-IV psychiatric diagnoses. Sixty-four (46.4%) of the hundred and thirty eight children were determined to have at least one psychiatric disorder. More boys were diagnosed as psychiatric patients than girls (46 males, 18 females; OR = 2.21). The most frequently diagnosed disorder was ADHD (46/64; 71.9%), followed by tic disorder, anxiety disorders, mental retardation, oppositional defiant disorder, and separation anxiety disorder. Two or more comorbid psychiatric disorders were found in 22 (34.4%) of the 64 patients. The computed crude percentage of psychiatric patients in this study was 4.12%, which is similar to previously published data.