Hee Jung Chung

Neurodevelopmental disorders (NDDs) comprise a heterogeneous group of conditions characterized by impairments in cognition, language, motor function, behavior, and social communication that originate during the developmental period. Advances in neuroscience, genomics, and digital health have substantially transformed the current understanding of the mechanisms, diagnosis, and management of NDDs. This review summarizes the contemporary conceptual framework of NDDs, highlights advances in etiological diagnosis—particularly those related to genetic and genomic technologies—and discusses emerging therapeutic approaches, including digital therapeutics. Emphasis is placed on the importance of early identification, domain-based assessment, and precision medicine approaches to optimize long-term outcomes.

Purpose: This study aimed to evaluate a hospital-provided hybrid parental support program designed to help parents implement routine interventions for their toddlers under 34 months, with or at risk of autism spectrum disorder (ASD).Methods: An experimental group including 15 pairs of toddlers and their parents received eight weekly sessions, while a control group including nine pairs received no sessions. Toddlers’ joint attention, autism-related behaviors, and adaptive behaviors, as well as parenting stress and parenting efficacy, were compared between baseline and 8 weeks later. Results: The toddlers in the experimental group showed significant improvement in their joint attention scores on the Early Social Communication Scales (P<0.01) and the Korean-Childhood Autism Rating Scale scores (P<0.01). However, statistically significant differences were not found in the adaptive behavior composite scores of the Korean Vineland Adaptive Behavior Scales-II and total behavior problem scores of the Korean version of the Child Behavior Checklist. Parenting efficacy in the experimental group showed significant improvement (P<0.05). Parenting stress increased in the experimental group, but the difference was not significant. Additionally, parents showed a statistically significant between-group difference in parenting efficacy (P<0.05). Conclusion: A hospital-provided hybrid program affected the development of toddlers with ASD and parents’ implementation of interventions. It is significant that an online platform was used to provide individualized support for families to continue practicing the interventions and that the effectiveness of this program was demonstrated. This intervention can be considered as an efficient and sustainable alternative system to support toddlers with ASD and their families.

본 연구는 Q방법론의 Q모집단 구성을 위한 FGI(Focus Group Interview)를 통해 코로나 상황에서의 보육실습의 현황을 파악하고 보육실습 경험을 통한 보육실습생의 주관적이고 개별적인 인식을 파악하는 데 연구의 목적이 있다. 연구참여자는 A시에 위치한 B대학교에 재학 중인 10명의 예비 보육교사인 영유아보육전공 학생으로 FGI를 실시하여 자료를 수집하고 분석하였다. 연구결과, 보육실습생들은 코로나 상황에서 보육실습 기관을 구하기가 매우 어려웠으며 코로나로 인해 한시적으로 적용된 4주 직접보육 실습기간은 보육실무 역량을 향상하는 데 있어 짧다고 인식하였고 코로나 상황에서도 기존의 보육실습 기간인 6주로 진행하는 것이 필요하다고 인식하였다. 또한, 코로나 방역지침에 따른 보육교사를 포함한 영유아의 마스크 착용으로 보육실습시의 영유아와의 상호작용에 어려움을 경험하였다. 코로나 상황에서 6주가 아닌 4주의 직접보육실습으로 실습지도 선생님께 많이 못 배운 점을 아쉬워하였으며 4주의 보육실습 기간동안 지도교사는 보육실습생의 보육직무 역량과 자질에 중요한 영향을 미쳤음을 알 수 있었다. 예비 보육교사인 영유아보육전공 학생들의 코로나 상황에서의 보육실습인식에 대한 연구결과를 기반으로 Q방법론을 활용한 보육실습 인식에 관한 주관성 연구의 Q모집단 구성을 위한 기초자료로 활용하고, 예비보육교사의 보육실무 역량을 강화할 수 있는 바람직한 보육실습 체계 및 보육 실습의 실행방안의 마련을 위한 연구자료로 활용되기를 기대한다.The aims of this study were to identify the current state of childcare practice in the corona pandemic using a FGI (Focus Group Interview) for the Q population composition of the Q methodology and to understand the subjective and individual perception of childcare trainees through childcare practice experience. In this study, data were collected and analyzed by conducting a FGI with 10 preliminary childcare teachers who were enrolled in B University located in A city majoring in early childhood care The results of this study show that it was very difficult for preliminary childcare teachers to find a childcare practice institution during the corona pandemic. The four-week direct childcare practice period (practicum), which was temporarily applied due to the corona pandemic, was perceived as too short to improve childcare practice competency. It was recognized that it was necessary to have the practicum for 6 weeks. In addition, it was difficult to interact with infants and toddlers during childcare practice because they and the childcare teachers had to wear masks in accordance with the Corona Prevention Guidelines. In the corona pandemic, it was regrettable that I did not learn much from the practical guidance teacher during the 4-week direct childcare practice which would have been more effective if 6 weeks long. Based on the research results on the perception of childcare practice students majoring in early childhood childcare who are preliminary childcare teachers during the corona pandemic, the Q methodology is used as basic data for the composition of the Q population to perform subjective research on childcare practice perceptions and preliminary childcare teachers. It is expected that the results of this study will be used as research data for the preparation of a desirable childcare practice system and implementation plan for childcare practice that can strengthen the childcare practice capabilities of children.

Moon JH, et al. J Clin Neurol. 2021 Jul;17(3):354-362. https://doi.org/10.3988/jcn.2021.17.3.354

Background: There is increasing concern that moderate preterm (32–33 weeks’ gestation) and late preterm (34–36 weeks’ gestation) birth may be associated with minor neurodevelopmental problems affecting poor school performance.Purpose: We explored the cognitive function, cognitive visual function, executive function, and behavioral problems at schoolage in moderate to late preterm infants.Methods: Children aged 7–10 years who were born at 32+0 to 36+6 weeks of gestation and admitted to the neonatal intensive care unit from August 2006 to July 2011 at the National Health Insurance Service Ilsan Hospital were included. We excluded children with severe neurologic impairments, congenital malformations, or chromosomal abnormalities. Neuropsychological assessments consisted of 5 neuropsychological tests and 3 questionnaires.Results: A total of 37 children (mean age, 9.1±1.2 years) participated. The mean gestational age at birth was 34.6±7.5 weeks, while the mean birth weight was 2,229.2±472.8 g. The mean full-scale intelligence quotient was 92.89±11.90; 24.3% scored between 70 and 85 (borderline intelligence functioning). An abnormal score was noted for at least one of the variables on the attention deficit hyperactivity disorder diagnostic system for 65% of the children. Scores below borderline function for executive quotient and memory quotient were 32.4% and 24.3%, respectively. Borderline or clinically relevant internalizing problems were noted in 13.5% on the Child Behavior Check List. There were no significant associations between perinatal factors or socioeconomic status and cognitive, visual perception, executive function, or behavior outcomes.Conclusion: Moderate to late preterm infants are at risk of developing borderline intelligence functioning and attention problems at early school age. Cognitive and executive functions that are important for academic performance must be carefully monitored and continuously followed up in moderate to late preterm infants.

To investigate the clinical characteristics of late-onset epilepsy combined with autism spectrum disorder (ASD), and the relationship between certain types of electroencephalography (EEG) abnormalities in ASD and associated neuropsychological problems. Thirty patients diagnosed with ASD in early childhood and later developed clinical seizures were reviewed retrospectively. First, the clinical characteristics, language and behavioral regression, and EEG findings of these late-onset epilepsy patients with ASD were investigated. The patients were then classified into 2 groups according to the severity of the EEG abnormalities in the background rhythm and paroxysmal discharges. In the severe group, EEG showed persistent asymmetry, slow and disorganized background rhythms, and continuous sharp and slow waves during slow sleep (CSWS). Between the two groups, there was no statistically significant difference in mean age (P=0.259), age of epilepsy diagnosis (P=0.237), associated family history (P=0.074), and positive abnormal magnetic resonance image (MRI) findings (P=0.084). The severe EEG group tended to have more neuropsychological problems (P=0.074). The severe group statistically showed more electrographic seizures in EEG (P=0.000). Rett syndrome was correlated with more severe EEG abnormalities (P=0.002). Although formal cognitive function tests were not performed, the parents reported an improvement in neuropsychological function on the follow up checkup according to a parent's questionnaire. Although some ASD patients with late-onset epilepsy showed severe EEG abnormalities, including CSWS, they generally showed an improvement in EEG and clinical symptoms in the long-term follow up. In addition, severe EEG abnormalities tended to be related to the neuropsychological function.

Purpose:Results of the Korea National Health Screening Program for Infants and Children, which was launched in November 2007, were evaluated for future research and policy development. Methods:Data from a total of 2,729,340 cases were analyzed. Five visiting ages, such as 4, 9, 18, 30, and 60 months, were included. Several parameters such as stunting, obesity, and positive rate of developmental screening were also analyzed. Telephone survey was performed in 1,035 users. For the provider survey, 262 doctors participated in our study. Results:The overall participation rate of users was 35.3%. This participation rate showed a decrement tendency to old age and low income. Only 6.9% of users participated in oral screening. Health screening was performed mainly in private clinics (82.6%). The recall rate of 4 months program users at the age of 9 months was 57.3%. The positive rate of screening was 3.1%, and was higher in the low-income group. By telephone survey, users reported that questionnaires were not difficult (94%) and overall satisfaction was good (73%). Longer duration of counseling was related with more satisfied users. Counseling and health education were helpful to users (73.2%). Doctors agreed that this program was helpful to children (98.5%). Conclusion:Korea National Health Screening Program for Infants and Children was launched successfully. Participation rate should be improved, and a quality control program needs to be developed. More intensive support following this program for children of low-income families may lead to effective interventions in controlling health inequality. Periodic update of guidelines is also needed

Purpose : Recent changes in the population structure of Korea, such as rapid decline in birth rate and exponential increase in old-aged people, prompted us to prepare a new health improvement program in children and adolescents. Methods : We reviewed current health screenings applied for children and adolescents in Korea and other developed countries. We collected and reviewed population-based data focused on mortality and morbidity, and other health-related statistical data. We generated problem lists in current systems and developed new principles. Results : Current health screening programs for children and adolescents were usually based on laboratory tests, such as blood tests, urinalysis, and radiologic tests. Almost all of these programs lacked evidence based on population data or controlled studies. In most developed countries, laboratory tests are used only very selectively, and they usually focus on primary prevention of diseases and health improvement using anticipatory guidance. In Korea, statistics on mortality and morbidity reveal that diseases related to lifestyle, such as obesity and metabolic syndrome, are increasing in all generations. Conclusion : We recommend a periodic health screening program with anticipatory guidance, which is focused on growth and developmental surveillance in infants and children. We no longer recommend old programs that are based on laboratory and radiologic examinations. School health screening programs should also be changed to meet current health issues, such as developing a healthier lifestyle to minimize risk behaviors—for example, good mental health, balanced nutrition, and more exercise