Kaplan B J, Dewey D M, Crawford S G, Wilson B N
Department of Paediatrics, University of Calgary, Alberta, Canada.
J Learn Disabil. 2001 Nov-Dec;34(6):555-65. doi: 10.1177/002221940103400608.
Over the last decade, there has been an enormous increase in the number of studies evaluating the overlap of developmental syndromes or disorders in both children and adults. This overlap of symptoms is often referred to as comorbidity, a term we criticize in this article because of its unsubstantiated presumption of independent etiologies. The premise of this article is that discrete categories do not exist in real life, and that it is misleading to refer to overlapping categories or symptoms as "comorbidities." We illustrate our point by presenting data from 179 school-age children evaluated with rigorous research criteria for seven disorders: reading disability (RD), attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD), oppositional defiant disorder (ODD), conduct disorder (CD), depression, and anxiety. Fully 50% of this sample met the criteria for at least two diagnoses. The children with ADHD were at higher risk of having at least a second disorder compared to the children with RD. Overall, the high rates of overlap of these behavioral, emotional, and educational deficits in this broadly ascertained sample support the idea that the concept of comorbidity is inadequate. We discuss the concept of atypical brain development as an explanatory idea to interpret the high rate of overlap of developmental disorders.
在过去十年中，评估儿童和成人发育综合征或疾病重叠情况的研究数量大幅增加。这种症状重叠通常被称为共病，我们在本文中对这个术语提出批评，因为它毫无根据地假定病因是独立的。本文的前提是，现实生活中不存在离散的类别，将重叠的类别或症状称为“共病”会产生误导。我们通过展示对179名学龄儿童进行评估的数据来阐述我们的观点，这些评估采用了针对七种疾病的严格研究标准：阅读障碍（RD）、注意力缺陷多动障碍（ADHD）、发育协调障碍（DCD）、对立违抗障碍（ODD）、品行障碍（CD）、抑郁症和焦虑症。该样本中足足50%的儿童符合至少两种诊断标准。与患有阅读障碍的儿童相比，患有注意力缺陷多动障碍的儿童患至少第二种疾病的风险更高。总体而言，在这个广泛确定的样本中，这些行为、情感和教育缺陷的高重叠率支持了共病概念并不充分的观点。我们讨论了非典型脑发育的概念，将其作为解释发育障碍高重叠率的一个解释性观点。
