Roessner Veit, Becker Andreas, Banaschewski Tobias, Freeman Roger D, Rothenberger Aribert
Dept. of Child and Adolescent Psychiatry/Psychotherapy, University of Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
Eur Child Adolesc Psychiatry. 2007 Jun;16 Suppl 1:24-35. doi: 10.1007/s00787-007-1004-6.
In Tourette syndrome (TS) as a neurodevelopmental disorder not only the tics but also the comorbid conditions change with increasing age. ADHD is highly comorbid with TS and usually impairs psychosocial functioning more than the tics. Its impact on further comorbidity during development is important for clinical practice and still a matter of debate.
Aspects of developmental psychopathology considering the impact of ADHD were examined by logistic regression (year wisely) in a cross-sectional sample of children and adolescents (n = 5060) from the TIC database.
In TS+ADHD (compared to TS-ADHD) higher rates of comorbid conditions like OCD, anxiety disorders, CD/ODD and mood disorders were found in children (5-10 years). In adolescents (11-17 years) higher comorbidity rates in TS+ADHD remained only for CD/ODD and mood disorders. Accordingly, for OCD and anxiety disorders there was a steeper year wise increase of these comorbidities in TS-ADHD while it was a similar for CD/ODD and mood disorders in TS-ADHD as well as TS+ADHD.
Children with TS+ADHD have more comorbidities than the TS-ADHD group, whereas in both adolescent groups this did no longer hold for OCD and anxiety disorders. These findings indicate that in TS comorbid ADHD is associated with high rates of externalizing and internalizing problems, whereas TS without ADHD is associated only with internalizing problems in adolescence.
抽动秽语综合征(TS)作为一种神经发育障碍,不仅抽动症状,而且共病情况都会随着年龄增长而变化。注意力缺陷多动障碍(ADHD)与TS高度共病,通常比抽动症状更易损害社会心理功能。其在发育过程中对进一步共病的影响对临床实践很重要,仍是一个有争议的问题。
在TIC数据库的儿童和青少年横断面样本(n = 5060)中,通过逻辑回归(逐年)研究了考虑ADHD影响的发育心理病理学方面。
在TS+ADHD(与TS-ADHD相比)中,儿童(5 - 10岁)出现强迫症(OCD)、焦虑症、对立违抗障碍(CD/ODD)和情绪障碍等高共病率。在青少年(11 - 17岁)中,TS+ADHD仅在CD/ODD和情绪障碍方面保持较高的共病率。因此,对于OCD和焦虑症,TS-ADHD中这些共病的逐年增加更为陡峭,而TS-ADHD以及TS+ADHD中CD/ODD和情绪障碍的情况相似。
TS+ADHD儿童的共病情况比TS-ADHD组更多,而在两个青少年组中,OCD和焦虑症的情况不再如此。这些发现表明,在TS中,共病的ADHD与外化和内化问题的高发生率相关,而无ADHD的TS仅与青少年期的内化问题相关。