RESUMO
OBJECTIVE: The aim of this study was to empirically determine subgroups of ADHD defined by specific patterns of psychopathology. METHOD: A clinical sample of 223 children with ADHD, aged 5 to 14 years, was examined with the Child Behavior Checklist (CBCL). In addition, comorbid psychiatric disorders, psychosocial risk factors, and socioeconomic status were assessed. RESULTS: Cluster analysis of CBCL subscales yielded a solution with four distinct subgroups. While "externalizers" showed a high rate of comorbid oppositional defiant disorder (ODD) and conduct disorder (CD), "obsessive-compulsives" exhibited thought problems, low rates of comorbid CD, and high symptoms of inattention. "High psychiatric symptom carriers" had high rates of familial risk factors, acute life events, comorbid ODD, and CD. "Low psychiatric symptom carriers" also scored low in all other variables studied. CONCLUSION: Children with ADHD can be divided into four subgroups according to their CBCL-based psychopathology, and these subgroups differ in their risk factor profiles.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Transtorno da Conduta/psicologia , Psicopatologia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , Criança , Análise por Conglomerados , Comorbidade , Transtorno da Conduta/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores SocioeconômicosRESUMO
According to DSM-IV TR and ICD-10, a diagnosis of autism or Asperger Syndrome precludes a diagnosis of attention-deficit/hyperactivity disorder (ADHD). However, despite the different conceptualization, population-based twin studies reported symptom overlap, and a recent epidemiologically based study reported a high rate of ADHD in autism and autism spectrum disorders (ASD). In the planned revision of the DSM-IV TR, dsm5 (www.dsm5.org), the diagnoses of autistic disorder and ADHD will not be mutually exclusive any longer. This provides the basis of more differentiated studies on overlap and distinction between both disorders. This review presents data on comorbidity rates and symptom overlap and discusses common and disorder-specific risk factors, including recent proteomic studies. Neuropsychological findings in the areas of attention, reward processing, and social cognition are then compared between both disorders, as these cognitive abilities show overlapping as well as specific impairment for one of both disorders. In addition, selective brain imaging findings are reported. Therapeutic options are summarized, and new approaches are discussed. The review concludes with a prospectus on open questions for research and clinical practice.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno Autístico/diagnóstico , Transtorno Autístico/epidemiologia , Predisposição Genética para Doença/psicologia , Animais , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno Autístico/tratamento farmacológico , Transtorno Autístico/genética , Transtorno Autístico/terapia , Terapia Comportamental/métodos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Comorbidade , Diagnóstico Diferencial , Humanos , Neuroimagem/psicologia , Testes Neuropsicológicos , Proteômica/estatística & dados numéricos , Fatores de RiscoRESUMO
Research indicates that autism is the extreme end of a continuously distributed trait. The Social Responsiveness Scale (SRS) and the Social and Communication Disorders Checklist (SCDC) aim to assess autistic traits. The objective of this study was to compare their clinical validity. The SRS showed sensitivities of .74 to .80 and specificities of .69 to 1.00 for autism. Sensitivities were .85 to .90 and specificities .28 to.82 for the SCDC. Correlations with the ADI-R, ADOS and SCQ were higher for the SRS than for the SCDC. The SCDC seems superior to the SRS to screen for unspecific social and communicative deficits including autism. The SRS appears more suitable than the SCDC in clinical settings and for specific autism screening.