Attention deficit hyperactivity disorder in Korean juvenile delinquents - Statistical Data Included

Adolescence, Winter, 2001 by Paul Kyuman Chae, Hyun-Oak Jung, Kyung-Sun Noh

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.