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Attention deficit hyperactivity disorder in Korean juvenile delinquents.

Attention deficit hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, impulsivity, and cognitive, behavioral, and emotional deficits. ADHD is also closely related to learning disabilities, lack of self-control, and social skill deficits (Morris & Collier, 1987). About 7.6% to 9.5% of Korean children are reported to have ADHD (Cho & Shin, 1994; Kim & Chae, 1998).

Approximately half of ADHD children show overt symptoms by the time they are 5 years old, and most begin to display behavioral problems during the early school years when they have to follow instructions from teachers and obey school rules. ADHD children are reported to have difficulty with self-control both at home and in school, to have a tendency to show aggressive behaviors, to suffer from low self-esteem, to have frequent fights with peers, to experience isolation in social situations, to display problems with underachievement, and to have learning disabilities (Silver, 1992).

Longitudinal studies on ADHD indicate that hyperactivity and impulsivity decrease during adolescence (Hart, Lahey, Loeber, Applegate, & Frick, 1995). However, about 70% to 80% of ADHD children carry the major symptoms of ADHD into their adolescent years (Barkley, Fischer, Edelbrock, & Smallish, 1990; Barkley, Anastopoulos, Guevremont, & Fletcher, 1991), and about 50% to 70% of ADHD children are likely to suffer from residual ADHD during adulthood (Weiss & Hechtman, 1993; Wenwei, 1996).

Because ADHD children tend to have risk factors in cognitive, academic, and medical areas, there is likely to be comorbidity with other disorders. Barkley (1998) states that about half suffer from additional liabilities, and it is estimated that 30% to 50% of ADKD outpatients and 40% to 70% of ADHD inpatients experience other psychiatric disorders.

According to Barkley (1998), the comorbidity rate of ADHD with oppositional defiant disorder (ODD) is 20% to 67%, 20% to 56% for conduct disorder (CD), 10% to 40% for anxiety disorder, and 9% to 32% for depression. ADHD children who have additional psychological problems are likely to have trouble with peers and to be avoided by them; they tend to be aggressive toward other children and act in a noncompliant manner at home. Biederman, Newcorn, and Sprich (1991) also noted that ADHD children tend to suffer from CD, depression, learning disabilities, and borderline personality disorder, and to display disruptive behaviors.

Hong, Kim, Shin, and An (1996) indicated that 48.8% of ADHD children have comorbid conditions, and that Korean ADHD inpatients experience an average of 2.7 additional disorders. They reported the following frequencies for those comorbid conditions: specific developmental disorders, 11.6%; CD, 9.3%; ODD, 7%; anxiety, 7%; enuresis, 4.7%; and mental retardation, 4.7%. Kim (1996) reported that 23% of ADHD children suffer from ODD, 16% experience extreme anxiety, and 8% suffer from CD. Other studies have found that about half of ADHD children have ODD or CD, while approximately a quarter have both.

Children with ADHD and CD often have problems dealing with family conflicts, as well as an unhappy social life due to deficits in social skills and cognitive inhibition (Barkley et al., 1991; Jensen, Martine, & Cantwell, 1997). In a longitudional study by Satterfield et al. (1982), it was found that 50% of a sample of 110 ADHD children committed theft, robbery, and physical assault, and 19% were incarcerated, while only 10% of 88 non-ADHD children committed crimes, with none being incarcerated.

On the other hand, there is not much research on the comorbidity of ADHD with youths who have CD. In one recent study, 23% of Korean adolescents with CD were also identified as having ADHD (Lee, Oh, Lim, Chung, & Cho, 1998), but most of the CD adolescents were selected from school settings with no parental and teacher's behavioral reports available for identifying ADHD.

The purpose of the present study was to identify the prevalence of ADHD among Korean juvenile delinquents using the TOVA system, parent and teacher behavioral ratings, adolescents' self-reports, and DSM-IV criteria. Additionally, the juvenile delinquents were compared with a group of nondelinquent adolescents in terms of intelligence, TOVA performance, behavioral characteristics, and self-esteem.

METHOD

Participants

The sample included 98 adolescents incarcerated at two juvenile correction centers located in Anyang, Korea. Their average age was 15.5 years, with a range of 12-18 years. Forty-nine were boys and 49 were girls, and they had been incarcerated for physical violence and larceny. However, 6 were excluded from the analyses because their Full Scale IQ was under 70 (IQ was computed based on the Brooker and Cyr system for WAIS and Sattler's, 1988, system for WISC, which uses the Vocabulary and Block Design subtests). Therefore, a total of 92 delinquent adolescents were included in this study.

The sample also included 84 adolescents recruited from four junior and senior high schools located in Seoul, Korea. This control group was matched with the juvenile delinquent group in terms of socioeconomic status. The average age of the adolescents in the control group was 14.6 years, with a range of 11-17 years. Forty-four were boys and 40 were girls, and they were identified as free from any legal troubles and behavioral problems.

Instruments

KEDI-WISC. The WISC-R was modified and standardized with Korean children who were 5-15 years old, producing the Korean Educational Developmental Institute--Wechsler Intelligence Scale for Children (KEDI-WISC). The KEDI-WISC evaluates Full Scale IQ, Verbal IQ, and Performance IQ, and consists of 12 subtests: Information, Similarities, Arithmetic, Vocabulary, Comprehension, Picture Completion, Picture Arrangement, Block Design, Object Assembly, Coding, Digit Span, and Mazes.

K-WAIS. The WAIS-R was also modified for the Korean culture and standardized with Korean adults (ranging from 16 to 64 years), producing the Korean-Wechsler Adult Intelligence Scale (K-WAIS). The KWAIS evaluates Full Scale, Verbal, and Performance IQs, and contains the same subtests as the KEDI-WISC except for Mazes.

TOVA. The Test of Variables of Attention (TOVA) is a continuous performance test (CPT) designed for the assessment of ADHD and the effects of medicinal treatment (Dupey & Greenberg, 1996). The test's visual mode was selected for use in this study and was administered for 22 minutes 30 seconds. The target and nontarget stimuli were presented for 100 milliseconds, and the interval between the stimuli lasted 2000 milliseconds.

The designated target was presented during the first half of the test in 22.2% of the trials and appeared during the second half for the remainder of the trials. Thus, the probability of Omission error was high in the first half; while the probability of commission error was high in the second half. That is, the stimuli were designed for generating both the low and high awakenings of the central nervous system. The varying target-nontarget ratio allowed for the examination of the effects of differing response demands on inattention and impulsivity.

In addition to omission error and commission error, TOVA detects response time, response variability, response sensitivity, multiple response, anticipatories, and postcommission response time. ADHD scores (computed via formulas using the above variables) of -1.80 or below were deemed to be indicative of ADHD.

K-CBCL and TRF. The Child Behavior Checklist (CBCL; Achenbach, 1991; Achenbach & Edelbrock, 1983), which is designed to assess problematic behaviors, was translated into Korean and standardized to produce the K-CBCL (Oh, Hong, Lee, & Ha, 1997). The K-CBCL was used in the present study to obtain parental reports of behavior.

The K-CBCL consists of Competence and Problem scales. The Problem scale contains items that represent the most common behavioral symptoms that occur during childhood and adolescence. The Competence scale evaluates social activities, school activities, and total competence, which indicates overall social competence. The K-CBCL has 119 items, which are rated on a 3-point scale: 0 (not true), 1 (somewhat or sometimes true), and 2 (very true or often true). The K-CBCL has demonstrated test-retest reliability (r = .68) and discriminative validity (p < .001).

The Teacher Report Form (TRF; Achenbach, 1991; Achenbach & Edelbrock, 1983) was translated into Korean and used to obtain the teacher's perceptions of functioning in the school setting. It contains 119 items and is structured like the CBCL.

YSR. The Youth Self-Report (YSR; Achenbach, 1991; Achenbach & Edelbrock, 1983) is designed for youths 11-18 years old. The Korean translation of the YSR (Kim, 1993) was used in the present study. It consists of 119 items and is divided into two areas: competence and behavior problems. Sixteen of the behavior problem items are related to social desirability and were excluded in scoring.

ADHD Assessment Questionnaire (based on DSM-IV criteria). DSMIV criteria (18 items) were used with youths' self-reports to assess ADHD. Nine items are related to inattention, and the other 9 items are related to impulsivity/hyperactivity. An individual rated as having significant problems on more than 6 items in an area is reported as experiencing inattention or impulsivity/hyperactivity, or both.

Rosenberg Self-Esteem Scale. The Rosenberg Self-Esteem Scale (RSE; Rosenberg. 1965) has been translated into Korean by Kim (1988), and this translation was used in the present study. The RSE is composed of 11 items, with response options ranging from "never agree" to "strongly agree." The scale has both positive and negative items related to self-esteem. Scores for negative items were reversed for the analyses. A high score represents high self-esteem. Kim (1988) reported good internal consistency for this scale (r = .84).

Procedure

The TOVA was administered in a place free from noise and distractions. The Youth Self-Report, Self-Esteem Scale, and ADHD Assessment Questionnaire (based on DSM-IV criteria) were completed by the adolescents and collected immediately. The TRF was completed by their teachers, who were given a week to turn in the forms.

The TOVA was administered after verbal instruction was given and adolescents had the opportunity to practice for two minutes. Only seven subtests of the KEDI-WISC and K-WAIS were administered: Information, Vocabulary, Arithmetic, Digit Span, Picture Arrangement, Block Design, and Coding. Vocabulary and Block Design were used to estimate Full Scale IQ, while Arithmetic, Coding, and Digit Span were used for the Freedom from Distractibility Factor. The Picture Arrangement subtest was selected because it is a type of sequential task that ADHD children will have difficulty with. The Information subtest was selected for its close relation to academic performance.

The final diagnosis of ADHD was made by a team of experienced clinical psychologists, and was based on adolescents' TOVA performance (ADHD score [less than or equal to] -1.80), the Teacher Report Form (Attention subscale [greater than or equal to] 98th percentile), and adolescents' self-reports (DSM-IV criteria).

Data Analysis

First, the chi-square test was conducted to determine the difference in prevalence of ADHD between the delinquent group and the control group. Second, two-way ANOVA was used to examine differences between the delinquent and control groups and between ADHD and nonADHD adolescents in terms of IQ, TOVA performance, behavioral symptoms of ADHD, and self-esteem. Third, one-way ANOVA was conducted to compare IQ, TOVA performance, behavioral symptoms of ADHD, and self-esteem between ADHD and non-ADHD delinquents and ADHD and non-ADHD control adolescents.

RESULTS

Comparison of ADHD Diagnosis Ratio Between Delinquent and Control Groups

Thirty-nine (42.4%) out of 92 adolescents were identified as having ADHD in the delinquent group, while only 10 (11.9%) of the 84 adolescents in the control group had ADHD (see Table 1). The difference in the ADHD diagnostic ratio between the delinquent and control groups was statistically significant, [X.sup.2](1) = 20.31, p < .001.

In terms of gender differences, 16 (33.3%) of the 48 male adolescents and 23 (52.3%) of the 44 female adolescents in the delinquent group were diagnosed with ADHD. Seven (15.9%) of the 44 males and 3 (7.5%) of the 40 females in the control group were identified as having ADHD.

While female adolescent delinquents were diagnosed with ADHD significantly more than their nondelinquent female counterparts, [X.sup.2](1) = 15.38, p < .001, the difference in ADHD ratio between them and their male counterparts was not statistically significant. Delinquent males were diagnosed with ADHD more than nondelinquent males.

Intellectual Functioning

KEDI-WISC (ages 15 and below). For adolescents ages 15 and below, the delinquent group had lower scores than the control group on the KEDI-WISC (see Table 2). Specifically, compared to the control group, the delinquent group had significantly lower scores on the following subtests: Information, F(1, 88) = 95.84, p < .001; Vocabulary, F(1, 88) = 57.49, p <.001; Arithmetic, F(1, 88) = 38.l4, p <.001; Digit Span, F(1, 88) = 6.26, p <.05; Block Design, F(1, 88) = 7.44, p < .01; and Coding, F(1, 88) = 63.71, p < .001. There was no significant difference for Picture Arrangement.

In addition, adolescents diagnosed with ADHD had lower scores than the non-ADHD adolescents (see Table 2). ADHD adolescents, in comparison to non-ADHD adolescents, had significantly lower scores on the following KEDI-WISC subtests: Information, F(1, 88) = 12.60, p <.001; Arithmetic, F(1, 88) = 5.02, p < .05; and Block Design, F(1, 88) = 4.30, p <.05. There were no significant differences in Vocabulary, Digit Span, Picture Arrangement, and Coding scores.

The delinquent ADHD adolescents (compared with delinquent non-ADHD, control ADHD, and control non-ADHD adolescents) had the worst scores on all the subtests except Block Design. Specifically, there were significant differences on the following subtests: Information, F(3, 88) = 36.15, p <.001; Vocabulary, F(3, 88) = 19.56, p <.001; Arithmetic, F(3, 88) = 14.70, p <.001; Digit Span, F(3, 88) = 3.17, p <.05; Block Design, F(3, 88) = 5.69, p <.001; and Coding, F(3, 88) = 21.90, p <.001. There was no significant difference for Picture Arrangement.

K-WAIS (ages 16 and above). On the K-WAIS, which was administered to adolescents ages 16 and above, the delinquent group had lower scores than the control group (see Table 3). Specifically, the delinquent group had significantly lower scores than the control group both on the Verbal subtests, namely Information, F(1, 78) = 28.97, p < .001; Vocabulary, F(1, 78) = 27.37, p <.001; Arithmetic, F(1, 78) = 25.49, p < .001; and Digit Span, F(1, 78) = 6.73, p < .05; and on the Performance subtests, namely Picture Arrangement, F(1, 78) = 4.39, p < .05; Block Design, F(1, 78) = 12.74, p < .001; and Coding, F(1, 78) = 15.68, p <.001.

Further, adolescents diagnosed with ADHD had lower scores on the K-WAIS subtests than the non-ADHD adolescents (see Table 3). However, these differences were not statistically significant.

The delinquent ADHD adolescents (compared with delinquent non-ADHD, control ADHD, and control non-ADHD adolescents) had the lowest scores on all the subtests except Picture Arrangement. Specifically, there were significant differences among the four groups on the following subtests: Information, F(3, 78) = 9.85, p <.001; Vocabulary, F(3, 78) 9.43, p < .001; Arithmetic, F(3, 78) = 8.88, p < .001; Block Design, F(3, 78) = 4.98, p < .01; and Coding, F(3, 78) 5.75, p < .001.

TOVA Performance

Table 4 shows that the delinquent group performed more poorly than the control group on the TOVA, except for response time (RT).

In comparison to the control group, the delinquent group displayed significantly poorer performance in terms of commission error, .F(1, 171) = 7.90, p < .01, and decrement in performance over time, F(1, 171) = 17.91, p < .001, but significantly better in regard to RT, F(1, 171) = 7.58, p < .01. The findings indicate that delinquent adolescents are more impulsive and not consistent in their performance.

ADHD adolescents did more poorly than non-ADHD adolescents in terms of omission error, commission error, RT, RT variability, decrement in performance over time, and ADHD score. The differences were statistically significant: omission error, F(l, 171) = 14.07, p < .001; commission error, F(1, 171) = 10.40, p < .01; RT, F(1, 171) = 7.20, p < .01; RT variability, F(1, 171) = 27.30,p < .001; decrement in performance over time, F(1, 171) = 34.80, p < .001; and ADHD score, F(1, 171) 103.07, p < .001. These results imply that adolescents with ADHD are more inattentive, impulsive, and inconsistent, and take more time in completing tasks.

Among all four subgroups, the delinquent ADHD adolescents showed the worst performance on omission error, commission error, RT variability, and decrement in performance over time, while the control ADHD adolescents demonstrated the worst performance on RT and ADHD score. The differences among the four subgroups were significant: omission error, F(3, 171) = 5.12, p <.01; commission error, F(3, 171) = 6.32, p <.001; RT, F(3, 171) = 5.07, p < .01; RT variability, F(3, 171) = 9.27, p <.001; decrement in performance over time, F(3, 171) = 18.41, p < .001; and ADHD score, F(3, 171) = 34.64, p <.001. These results indicate that delinquent ADHD adolescents are inattentive, impulsive, and inconsistent in their performance, while nondelinquent ADHD adolescents are likely to take more time to process information.

Behavioral Characteristics

TRF. ANOVA revealed that, compared with non-ADHD adolescents, ADHD adolescents were reported by their teachers to have more problems: Aggression, F(1, 172) = 19.18p < .001; Anxious/Depressed, F(1,172) = 8.27, p <.01; Attention Problems, F(1, 172) = 22.55, p <.001; Delinquency, F(1, 172) = 20.51, p <.001; Somatization, F(1, 172) = 9.27, p <.01; Social Problems, F(1, 172) = 15.46, p < .001; Thought Problems, F(1, 172) = 8.28, p <.01; Withdrawn, F(1, 172) = 21.86, p <.001; Internalizing, F(1, 172) 15.61, p <.001; and Externalizing, F(1, 172) = 23.50, p <.001 (see Table 5). The results indicate that adolescents with ADHD have a tendency to blame others for their problems.

Among the four subgroups, the delinquent ADHD adolescents were rated as having the worst problems: Aggression, F(3, 172) = 28.72, p <.001; Anxious/Depressed, F(3, 172) = 11.20, p <.001; Attention Problems, F(3, 172) = 31.06, p <.001; Delinquency, F(3, 172) = 29.94, p <.001; Somatization, F(3, 172) = 14.60, p <.001; Social Problems, F(3, 172) = 14.76, p <.001; Thought Problems, F(3, 172) = 14.42, p <.001; Withdrawn, F(3, 172) = 25.92, p <.001; Internalizing, F(3, 172) = 20.84, p <.001; and Externalizing, F(3, 172) = 34.90, p <.001. That is, if delinquents suffer from ADHD, they will be perceived by their teachers to have more troubles than any other adolescents.

YSR. ANOVA showed that delinquent youths self-reported that they have more troubles, compared to nondelinquent youths, in the following domains: Aggression, F(1, 172) = 25.18, p < .001; Anxious/Depressed, F(1, 172) = 26.27, p <.001; Attention Problems, F(1, 172) = 13.95, p < .001; Delinquency, F(1, 172) = 220.85, p <.001; Somatization, F(1, 172) = 21.92, p < .001; Social Problems, F(1, 172) = 3.88, p <.05; Withdrawn, F(1, 172) = 17.95,p < .001; Internalizing, F(1, 172) = 28.97, p <.001; and Externalizing, F(1, 172) = 85.32, p < .001 (see Table 6). These findings indicate that delinquent adolescents admit to more internal and behavioral problems than nondelinquent adolescents, and they tend to blame others for their problems.

ANOVA also revealed that ADHD adolescents indicated more problems than non-ADHD adolescents in the following areas: Anxious/Depressed, F(1, 172) = 4.55, p < .05; Attention Problems, F(1, 172) = 4.22, p <.05; Social Problems, F(1, 172) = 4.09, p < .05; Withdrawn, F(1, 172) = 5.50, p <.05; Internalizing, F(1, 172) = 5.78, p <.05; and Externalizing, F(1, 172) 4.30, p <.05.

Further, ANOVA revealed that, among the four subgroups, the delinquent ADHD youths self-reported the worst problems: Aggression, F(3, 172) = 9.86, p <.001; Anxious/Depressed, F(3, 172) = 10.69, p < .001; Attention Problems, F(3, 172) = 6.09, p <.001; Delinquency, F(3, 172) = 74.91, p < .001; Somatization, F(3, 172) = 8.49, p <.001; Social Problems, F(3, 172) = 3.07, p < .05; Withdrawn, F(3, 172) = 7.92, p <.001; Internalizing, F(3, 172) = 11.68, p < .001; and Externalizing, F(3, 172) 30.11, p <.001.

Self-Esteem

The delinquent group self-reported significantly lower self-esteem than the control group, F(1, 171) = 28.58, p < .001 (see Table 7). The non-ADHD adolescents' self-esteem was higher than that of the ADHD adolescents, but the difference was not statistically significant. Among the four subgroups, the delinquent ADHD adolescents had the lowest self-esteem, F(3, 171) 10.97, p < .001.

DISCUSSION

A significantly higher percentage of delinquent adolescents, compared with nondelinquent adolescents, were identified as having ADHD (42.4% vs. 11.9%, respectively). This finding is consistent with previous studies, in which about half of CD or ODD patients were reported to suffer from ADHD (Abikoff & KLein, 1992; Hector et al., 1988). It also conforms to previous Korean studies, which have reported comorbidity rates of 23.9% to 72.4% (Cho & Shin, 1994).

ADHD prevalence was higher among female delinquents than male delinquents (52.3% vs. 33.3%), although the difference was not statistically significant. However, this supports the findings by Szatmari, Boyle, and Offord (1989); they reported higher comorbidity of ADHD and CD in females than males. It is important to point out that the male-to-female ADHD ratio has been reported to range from 6:1 to 2:1 in the general population (American Psychiatric Association, 1994). It is speculated that female delinquents are very impulsive and have problems in school because of ADHD.

Delinquent adolescents and adolescents with ADHD were found to have lower IQ scores, poorer TOVA performance, more severe problem behaviors, and lower self-esteem than nondelinquent adolescents and adolescents without ADHD. Delinquent adolescents with ADHD consistently fared the worst on assessments of intelligence, TOVA performance, problem behaviors, and self-esteem.

Specifically, this study yielded the following information on the characteristics of delinquent and ADHD adolescents: First, regarding intelligence, the delinquent group demonstrated lower Verbal IQ and Performance IQ than the control group. This was especially true on the Information subtest, which reflects academic performance. Two possible explanations are that delinquents did poorly in school because of lower intellectual functioning, or, alternatively, delinquents underachieved in school because of ADHD. For example, unidentified ADHD children have difficulty adjusting to school and completing academic assignments, and may engage in delinquent behaviors that lead to incarceration. This is consistent with a previous study conducted with 435 male adolescents (Moffitt, 1990). Moffitt reported that (1) attention deficit disorder (ADD) and non-ADHD groups differed slightly in intelligence and reading ability, with non-ADHD males faring better, (2) delinquents had poorer IQ and reading ability than nondelinque nts, and (3) delinquents with ADD obtained the worst scores compared with the other groups in terms of Verbal IQ and reading ability.

There were few significant differences between the ADHD and non-ADHD adolescents in terms of intelligence. However, the lower IQ scores of the ADHD adolescents confirms previous research showing that ADHD youths have low IQ, cognitive deficits, and difficulties in school (McGee, Williams, Moffitt, & Anderson, 1989; Milich & Loney, 1979; Morris & Collier, 1987; Prior, Leonard, & Wood, 1983).

Second, on TOVA performance, the delinquent group fared worse than the control group on commission error and decrement in performance over time. In particular, the fact that the delinquent group demonstrated poorer performance regarding commission error, which is designed to measure impulsivity or inhibition of reaction, reflects delinquent adolescents' lack of self-control.

The ADHD adolescents, compared with non-ADHD adolescents, showed poorer performance in terms of omission error, commission error, RT, RT variability, decrement in performance over time, and ADHD score. These results are consistent with previous studies. Kim (1994) reported that ADHD children suffer performance deficits in omission error, commission error, RT, and RT variability. Kim and Kim (1996) reported that ADHD children perform poorly in terms of omission error, RT, and RT variability.

Third, on the TRF, teachers reported that the delinquent adolescents and ADHD adolescents had more significant problems with regard to aggression, anxiety and depression, attention, delinquency, somatization, social interaction, withdrawal, internalizing, and externalizing than the nondelinquent adolescents and non-ADHD adolescents. This trend was generally confirmed by the delinquents' self-reports on the YSR. These results are consistent with those of Eiraldi, Power, and Nezu (1997) and Moffitt (1990), who reported that ADED youths tend to internalize and externalize their problems more than non-ADHD youths.

Fourth, the self-esteem of delinquent ADHD adolescents was found to be the lowest among the four subgroups. This implies that delinquents' self-esteem worsens due to ADHD. This is consistent with previous studies which reported a severe decline in self-esteem among ADHD delinquents (Feldman, Denhoff, & Denhoff, 1979; Stewart, Mendelson, & Johnson, 1973). Similarly, Wilson and Marcotte (1996) noted social, emotional, and adaptive difficulties in delinquent ADHD adolescents. The low self-esteem of delinquent ADHD adolescents is likely to be exacerbated by their school underachievement, and in turn they are likely to act out aggressively with peers. Thus, the treatment of many juvenile delinquents should include efforts to help them cope with the side effects of ADKD.

A limitation of the present study was that adolescents were not classified according to subtypes of ADHD because of the lack of relevant data. Therefore, differences among ADHD subtypes could not be explored. Future studies should address this issue.

Research and interventions with juvenile delinquents have focused on the dysfunctional nature of the family, problems in the social environment, and school shortcomings (e.g., overcrowded classrooms), as well as individual factors such as IQ and low motivation. However, this study suggests that screening for ADHD is crucial because of the high prevalence of ADHD among the delinquent population. It is also alarming that more than half of the female juvenile delinquents were identified as having ADHD in this particular sample. In the Korean school system, female students with problems may not be receiving the attention they require and, overlooked and untreated, they may end up in a juvenile correction center. In conclusion, routine ADHD screening is critically important for the proper diagnosis and appropriate treatment of underperforming students and delinquent adolescents alike.
Table 1

Group Comparisons on ADHD Diagnostic Ratio

 Delinquent group Control group
 male (%) female (%) total (%) male (%) female (%)

ADHD 16 (33.3) 23 (52.3) 39 (42.4) 7 (15.9) 3 (7.5)
non-ADHD 32 (66.7) 21 (47.7) 53 (57.6) 37 (84.1) 37 (92.5)

 Control
 group
 total (%)

ADHD 10 (11.9)
non-ADHD 74 (88.1)
Table 2

Group Comparisons on KEDI-WISC (ages 15 and below)

 Delinquent Control
 ADHD non-ADHD ADHD non-ADHD
 n = 23 n = 17 n = 5 n = 47 2 group (1)
 M (SD) M (SD) M (SD) M (SD) F

Information 5.39 7.59 9.20 11.19 95.84 (***)
 (2.62) (3.12) (2.59) (1.61)
Vocabulary 8.65 9.18 12.00 13.09 57.49 (***)
 (2.82) (2.82) (3.16) (2.20)
Arithmetic 6.26 8.59 10.60 11.26 38.14 (***)
 (2.75) (4.26) (1.52) (2.74)
Digit Span 9.32 10.59 10.00 11.51 6.26 (*)
 (2.85) (3.45) (2.00) (2.61)
Picture 10.13 10.65 12.00 10.98 1.83
Arrangement (2.56) (1.93) (2.24) (2.75)
Block 10.26 10.59 8.60 12.15 7.44 (**)
Design (2.54) (2.21) (3.29) (2.40)
Coding 6.91 7.88 11.40 13.11 63.71 (***)
 (4.00) (4.74) (2.51) (2.32)



 ADHD (2) 4 group (3)
 F F

Information 12.60 (***) 36.15 (***)

Vocabulary 1.06 19.56 (***)

Arithmetic 5.02 (*) 14.70 (***)

Digit Span 3.22 3.17 (*)

Picture .00 .98
Arrangement
Block 4.30 (*) 5.69 (***)
Design
Coding 1.84 21.90 (***)


(*)p <.05

(**)p <.01

(***)p <.001

(1)Comparison of delinquent group with control group.

(2)Comparison of ADHD adolescents with non-ADHD adolescents.

(3)Comparisons among delinquent ADHD, delinquent non-ADHD, control ADHD,
and control non-ADHD.
Table 3.

Group Comparisons on K-WAIS (ages 16 and above)

 Delinquent Control
 ADHD non-ADHD ADHD non-ADHD
 n = 16 n = 36 n = 5 n = 25 2 group (1)
 M (SD) M (SD) M (SD) M (SD) F

Information 7.44 7.69 9.20 9.60 28.97 (***)
 (1.46) (1.31) (1.79) (1.87)
Vocabulary 7.63 8.11 10.00 10.60 27.37 (***)
 (1.93) (1.85) (2.83) (2.43)
Arithmetic 7.25 8.03 10.60 10.56 25.49 (***)
 (2.65) (2.36) (1.67) (2.40)
Digit Span 10.38 10.39 11.40 11.64 6.73 (*)
 (2.31) (2.05) (2.51) (1.75)
Picture 10.06 9.50 9.60 10.76 4.39 (*)
Arrangement (1.48) (1.68) (2.51) (2.17)
Block 9.63 10.06 13.00 11.52 12.74 (***)
Design (1.96) (1.88) (2.55) (2.80)
Coding 10.31 10.86 11.80 12.56 15.68 (***)
 (1.78) (1.79) (2.17) (2.12)



 ADHD (2) 4 group (3)
 F F

Information .55 9.85 (***)

Vocabulary .91 9.43 (***)

Arithmetic .81 8.88 (***)

Digit Span .02 2.26 (*)

Picture .03 2.34 (*)
Arrangement
Block .02 4.98 (**)
Design
Coding 1.52 5.75 (***)


(*)p < .05

(**)p < .01

(***)p < .001

(1)Comparison of delinquent group with control group.

(2)Comparison of ADHD adolescents with non-ADHD adolescents.

(3)Comparison among delinquent ADHD, delinquent non-ADHD, control ADHD,
and control non-ADHD.
Table 4. Group Comparisons on TOVA

 Delinquent Control
 ADHD non-ADHD ADHD non-ADHD
 M (SD) M (SD) M (SD) M (SD)

Omission 3.97 1.56 2.59 1.37
(%) (4.97) (1.68) (1.78) (3.77)
Commission 5.01 4.14 4.41 2.55
(%) (3.89) (2.98) (3.07) (2.61)
RT (msec) 380.92 338.42 395.20 368.95
 (61.75) (45.93) (89.67) (66.40)
RT variability (msec) 129.31 89.60 118.50 89.27
 (46.28) (25.98) (24.26) (51.65)
Decrement in performance 3.71 4.29 3.89 5.12
over time (0.75) (0.91) (0.77) (1.23)
ADHD score -2.84 .44 -3.15 .72
 (2.66) (1.44) (2.46) (1.53)


 2 group (1) ADHD (2) 4 group (3)
 F F F

Omission .57 14.07 (***) 5.12 (**)
(%)
Commission 7.90 (**) 10.40 (**) 6.32 (***)
(%)
RT (msec) 7.58 (**) 7.20 (**) 5.07 (**)

RT variability (msec) .13 27.30 (***) 9.27 (***)

Decrement in performance 17.91 (***) 34.80 (***) 18.41 (***)
over time
ADHD score .30 103.07 (***) 34.64 (***)


(*)p<.05

(**)p<.01

(***)p<.001

(1)Comparison of delinquent group with control group.

(2)Comparison of ADHD adolescents with non-ADHD adolescents.

(3)Comparison among delinquent ADHD, delinquent non-ADHD, control ADHD,
and control non-ADHD.
Table 5

Group Comparisons on TRF

 Delinquent Control
 ADHD non-ADHD ADHD non-ADHD 2 group (1)
 M (SD) M (SD) M (SD) M (SD) F

Aggression 8.94 4.75 2.10 1.94 60.19 (***)
 (5.63) (3.33) (2.07) (3.29)
Anxious/ 6.79 3.83 1.90 3.25 15.09 (***)
depressed (3.86) (3.26) (1.66) (3.38)
Attention 10.76 6.03 3.10 3.85 57.13 (***)
problems (4.93) (3.15) (1.96) (3.59)
Delinquency 3.02 1.24 .10 .22 59.49 (***)
 (2.72) (1.35) (.31) (.58)
Somatization 2.50 1.17 .20 .59 26.46 (***)
 (2.06) (1.53) (.42) (1.24)
Social 7.17 4.49 3.60 3.77 21.63 (***)
problems (3.31) (2.15) (1.57) (2.75)
Thought 1.76 .88 .20 .25 31.12 (***)
problems (1.85) (1.26) (.42) (.66)
Withdrawn 4.76 2.13 .80 1.14 43.67 (***)
 (2.93) (2.06) (.78) (1.81)
Internalizing 13.48 6.94 2.90 4.93 33.13 (***)
 (7.25) (5.78) (1.66) (5.27)
Externalizing 11.97 6.00 2.20 2.17 72.09 (***)
 (7.78) (4.23) (2.04) (3.62)


 ADHD (2) 4 Group (3)
 F F

Aggression 19.18 (***) 28.72 (***)

Anxious/ 8.27 (**) 11.20 (***)
depressed
Attention 22.55 (***) 31.06 (***)
problems
Delinquency 20.51 (***) 29.94 (***)

Somatization 9.27 (**) 14.60 (***)

Social 15.46 (***) 14.76 (***)
problems
Thought 8.28 (**) 14.42 (***)
problems
Withdrawn 21.86 (***) 25.92 (***)

Internalizing 15.61 (***) 20.84 (***)

Externalizing 23.50 (***) 34.90 (***)


(*)p < .05

(**)p < .01

(***) p < .001

(1)Comparison of delinquent group with control group.

(2)Comparison of ADHD adolescents with non-ADHD adolescents.

(3)Comparisons among delinquent ADHD, delinquent non-ADHD, control
ADHD, and control non-ADHD.
Table 6.

Group Comparisons on YSR

 Delinquent Control
 ADHD non-ADHD ADHD non-ADHD 2 group (1)
 M (SD) M (SD) M (SD) M (SD) F

Aggression 14.46 13.00 12.20 8.89 25.18 (***)
 (5.73) (6.98) (4.75) (4.73)
Anxious/ 13.48 10.88 8.30 7.98 26.27 (***)
depressed (5.66) (5.37) (2.83) (4.86)
Attention 8.35 7.15 6.70 5.87 13.95 (***)
problems (2.91) (3.11) (1.41) (3.08)
Delinquency 10.46 9.67 4.50 2.86 220.85 (***)
 (3.43) (3.95) (2.50) (2.14)
Somatization 5.15 4.39 3.90 2.44 21.92 (***)
 (3.59) (3.42) (2.68) (2.19)
Social 4.66 3.43 3.30 3.18 3.88 (*)
problems (3.17) (2.59) (1.63) (2.18)
Thought 2.17 1.86 3.30 1.85 .00
problems (1.57) (1.79) (2.31) (2.02)
Withdrawn 5.92 4.71 4.20 3.55 17.95 (***)
 (2.50) (2.59) (1.61) (2.51)
Internalizing 23.53 19.28 16.10 13.76 28.97 (***)
 (9.36) (9.59) (4.81) (7.84)
Externalizing 24.92 22.67 16.70 11.75 85.32 (***)
 (8.55) (10.11) (6.41) (6.19)


 ADHD (2) 4 group (3)
 F F

Aggression 3.75 9.86 (***)

Anxious/ 4.55 (*) 10.69 (***)
depressed
Attention 4.22 (*) 6.09 (***)
problems
Delinquency 3.40 74.91 (***)

Somatization 3.22 8.49 (***)

Social 4.09 (*) 3.07 (*)
problems
Thought 3.52 1.94
problems
Withdrawn 5.50 (*) 7.92 (***)

Internalizing 5.78 (*) 11.68 (***)

Externalizing 4.30 (*) 30.11 (***)


(*)p <.05

(**)p < .01

(***)p <.001

(1)Comparison of delinquent group with control group.

(2)Comparison of ADHD adolescents with non-ADHD adolescents.

(3)Comparisons among delinquent ADHD, delinquent non-ADHD, control ADHD,
and control non-ADHD.
Table 7

Group Comparisons on Self-Esteem

 Delinquent Control
 ADHD non-ADHD ADHD non-ADHD 2 group (1)
 M (SD) M (SD) M (SD) M (SD) F

Self-Esteem 25.97 26.90 27.70 30.54 28.58 (***)
 (4.20) (4.63) (3.16) (4.80)



 ADHD (2) 4 group (3)
 F F

Self-Esteem 3.24 10.97 (***)



(*.)p < .05

(**.)p < .01

(***.)p < .001

(1)Comparison of delinquent group with control group.

(2)Comparison of ADHD adolescents with non-ADHD adolescents.

(3)Comparisons among delinquent ADHD, delinquent non-ADHD, control
ADHD, and control non-ADHD.


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This study was supported by a Sungshin Women's University Scholarship Grant in 2000.

Paul Kyuman Chae, Ph.D., Sungshin Women's University, Seoul, Korea.

Hyun-Oak Jung, M.A., Sungshin Women's University, Seoul, Korea.

Kyung-Sun Noh, M.D., Kangbuk Samsung Hospital, Seoul, Korea.

Reprint requests to Paul Kyuman Chae, Department of Psychology, Sungshin Women's University, 249-1 3Ga Dongsung-Dong, Sungbuk-Ku, Seoul 136-742, Korea. Electronic mail may be sent to kmchae@cc.sungshin.ac.kr.
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Author:Chae, Paul Kyuman; Jung, Hyun-Oak; Noh, Kyung-Sun
Publication:Adolescence
Article Type:Statistical Data Included
Geographic Code:9SOUT
Date:Dec 22, 2001
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