This study separately investigated both the experience with each treatment and the current use of the treatment; information regarding the experience rate and the current utilization rate were thus differentially obtained.
First, focusing on ever having had CAM, the present study revealed that the experience rate for CAM was 51.5 %, which was higher than the rate of experiencing CAM in children who visited a neurologic clinic in Canada (44 %)  and lower than that of children with a brain injury in the United Kingdom (UK, 59 %) . Although we were unable to compare these populations directly because the CAM list in each study consisted of different therapies and the disease in each study also differed, approximately one-half of the children with neuropsychiatric diseases generally seemed to have experienced CAM. Focusing on a specific disease, the above-mentioned Canadian study indicated an experience rate of 39 % in epilepsy and 38 % in brain injuries , and another study conducted in Canada revealed an experience rate of 35.3 % in CP . These results cannot be directly compared, but the studies found a relatively lower experience rate than our present study, which mainly included patients with epilepsy and CP.
Next, regarding the current utilization rate, our present study revealed a 19.0 % utilization rate at the time the survey was performed (21.9 % in epilepsy, 16.1 % in CP and 11.8 % in those with a developmental disorder). Studies on the current use are limited, but a study conducted in the UK found a use rate of 9.4 % in CP , which was lower than the result of our present study.
This distinction can be identified in the utilization rate according to each CAM therapy. Our study revealed a current utilization rate of 12.5 % for dietary supplements, 4.1 % for traditional Korean herbal medicine, and 2.2 % for acupuncture. Comparing with studies that were performed with similar diseases, Soo’s study  in children who visited a pediatric neurologic clinic indicated that 15 % used chiropractic manipulations, 12 % used dietary therapy, 8 % used herbal remedies, 8 % used homeopathy and 8 % used prayer/faith healing. Cheshire’s study  of children with a brain injury revealed that 22.4 % used massage, 21.4 % used osteopath/cranial osteopathy, 18.4 % used aromatherapy, 15.3 % used omega-3 and omega-6 oil supplements and 14.3 % used homeopathy. In Korea, children with neuropsychiatric disease were using a relatively limited set of CAM therapies, whereas in western countries, patients seemed to be using an even distribution of more varied CAM therapies.
We analyzed the patient characteristics in each CAM group, the other rehabilitation therapies group and the non-use group, and the results revealed a longer disease duration in both the CAM group and the other rehabilitation therapies group. There were also more cases of having other health problems in these groups. Among the other health problems, the presence of common upper respiratory infections was the most frequent (27.3 %), and growth retardation was the second most common problem (20.0 %) in CAM group.
Additionally, the mean ages of the three groups were significantly different, and this difference was still statistically significant according to the adjusted ORs. In both the CAM and other rehabilitation therapies groups, those aged 13–19 years used the fewest treatments. In the CAM group, those aged 7–12 years used the most, with an OR of 3.34, followed by those aged 1–6 years with an OR of 3.14. In the other rehabilitation therapies group, those aged 1–6 years used the most therapies, with an OR of 6.92, followed by those aged 7–12 years with an OR of 2.31. This result suggests that parents tend to seek rehabilitation therapies as much as possible at an early stage, and over time, some of the guardians move to CAM treatments or others stop both types of treatment. Hurvitz’s study  on CP children indicated that the younger the patient, the higher the utilization rate of CAM, which does not correspond with our results. This discordance might be caused by the variation in the target diseases and types of CAM investigated and by the difference in health care use between the two countries. In the social context of Korea, there is increasing difficulty to continue outpatient treatment as the school year of the patients increases; therefore, we classified the patients into three groups: 1–6 years (before entering elementary school), 7–12 years (during elementary school), and 13–19 years (during middle school and high school). Consequently, preschool children were the most prevalent group in the other rehabilitation therapies group, and elementary school children were the most prevalent group in the CAM group. Various CAM therapies are not widely used in Korea as mentioned earlier; thus, parents seem to first encounter other rehabilitation therapies which are more easily accessible, and they seem to use CAM later when starting to seek other additional treatment if the patients’ disease is not resolved and the disease duration increases. This phenomenon corresponds with the results of Sanders’ study , which demonstrated that CAM is more frequently used by those with un-treatable diseases than those with treatable diseases. The OR decreased from 6.92 in the 1–6-years-old age group to 2.31 in the 7–12-years-old age group in the other rehabilitation therapies group, but the OR increased from 3.14 at 1–6 years of age to 3.31 at 7–12 years of age, which implies that preschool children visit hospitals and receive rehabilitation therapies frequently, but school-aged children tend to change to food or drug intake, which does not require a healthcare visit.
In the present study, we only investigated disease duration and not disease severity. When the disease duration was divided into two groups of equal to or more than 48 months and lesser than 48 months, patients with longer disease duration exhibited a significantly higher utilization rate in not only the other rehabilitation therapies but also the CAM group. This result corresponds with other previous studies, and it can be interpreted that CAM is more frequently used in chronic or severe diseases. Samdup’s study  also showed increased CAM use in those with greater disease severity of CP. Previous studies also revealed that CAM use is greater in those with more seizures in epilepsy patients , more severe diseases or degree  of disability , and greater inability of independent ambulation .
A limitation of this study was the lack of considering the socio-economic factors that are known to affect CAM use, including parents’ age, education background, and economic level. Previous studies have shown that parents’ past CAM use experiences affect their children’s current CAM use [18, 25, 28, 30]; thus, it can be inferred that decision makers’ experiences have significant effects on their children’s treatment. In addition to the parents’ past CAM use, their socio-economic factors affect the children’s CAM use, as shown in previous studies. A higher parental education level [18, 22, 25], older father’s age , and higher parental socio-economic status  were associated with higher CAM use in children. Greater parental agreement with CAM philosophy  was also associated with more frequent CAM use compared to those who do not agree.
Another limitation is that the subjects who had several heterogeneous diseases and the severity of disease, which can affect the use of CAM, were not objectively identified.
In addition, only the opinions of the parents and not those of their children were surveyed. However, this study is meaningful because we analyzed children with neuropsychiatric disorders, which have not been investigated in previous studies. We considered their clinical characteristics and the use of other rehabilitation therapies to analyze the factors of CAM use. Further studies are required to confine the survey to one disease with a more detailed division of each subsection that represents the patient characteristics. Further studies should also evaluate various family factors such as the parents’ socio-economic level.