Roessner Veit, Becker Andreas, Banaschewski Tobias, Rothenberger Aribert
Dept. of Child and Adolescent Psychiatry/Psychotherapy, University of Goettingen, Von Siebold-Str. 5, 37075, Goettingen, Germany.
Eur Child Adolesc Psychiatry. 2007 Jun;16 Suppl 1:36-44. doi: 10.1007/s00787-007-1005-5.
In Chronic Tic Disorders (CTD) associated Attention Deficit Hyperactivity Disorder (ADHD) is very common. Hence, it is important to clarify how both conditions are related to cognitive dysfunctions in patients with CTD+ADHD comorbidity. Recent studies on neuropsychology revealed equivocal results, mostly due to methodological shortcomings like problems in sample composition. Thus better and more detailed information on this topic is needed to improve diagnostic and treatment approaches.
Three tasks related to different domains of executive functions (the Matching Familiar Figures Test, the Stroop color-word interference task, and a computerized version of the Wisconsin Card Sorting Test) have been performed in two independent samples (altogether n = 138 children) both including four groups of children (CTD-only, CTD+ADHD, ADHD-only, healthy controls) matched for age and IQ. To specify the influence of either tics or ADHD-symptoms on executive functions and to answer the question of their interactive or additive relationship two-way analyses of variance (MANOVA) for the factors CTD (yes,-no) x ADHD (yes,no) were conducted. Eta squared was calculated to reveal the effect sizes for each factor. For a deeper understanding of group differences and to better enable the comparison with data in literature, additional analyses of variance (ANOVA) with posthoc testing were applied.
In summary, there was a main effect only for the factor ADHD reflected by decreased performance, while no main effect of the factor CTD could be found. Admittedly, the effects were not uniform in both samples. However, in all three tasks and both samples, uniformly no interaction between the main factors has been observed.
In cases of coexisting CTD+ADHD the factor ADHD shows the main negative impact on neuropsychological performance and this impact seems to be independent of any feature of the coexisting tics (additive model). This supports the notion to primarily treat the ADHD-symptoms in order to increase cognitive self regulatory abilities of these children. Contrarily, tics seem to have little impact on cognitive performance in most cases.
在慢性抽动障碍（CTD）中，注意缺陷多动障碍（ADHD）非常常见。因此，明确这两种病症如何与CTD+ADHD共病患者的认知功能障碍相关很重要。近期关于神经心理学的研究结果并不明确，主要是由于样本构成等方法学缺陷。因此，需要关于该主题更完善、更详细的信息以改进诊断和治疗方法。
在两个独立样本（共n = 138名儿童）中进行了三项与执行功能不同领域相关的任务（匹配熟悉图形测验、斯特鲁普颜色-词语干扰任务以及威斯康星卡片分类测验的计算机版本），两个样本均包括四组年龄和智商匹配的儿童（仅患CTD组、CTD+ADHD组、仅患ADHD组、健康对照组）。为明确抽动或ADHD症状对执行功能的影响，并回答它们的交互或相加关系问题，对CTD（是，否）×ADHD（是，否）因素进行了双向方差分析（MANOVA）。计算了偏 eta 平方以揭示每个因素的效应大小。为更深入理解组间差异并更好地与文献数据进行比较，应用了带有事后检验的额外方差分析（ANOVA）。
总体而言，仅发现ADHD因素有主要效应，表现为成绩下降，而未发现CTD因素的主要效应。诚然，两个样本中的效应并不一致。然而，在所有三项任务及两个样本中，均未观察到主要因素之间的交互作用。
在CTD+ADHD共存的情况下，ADHD因素对神经心理表现有主要负面影响，且这种影响似乎独立于共存抽动的任何特征（相加模型）。这支持了主要治疗ADHD症状以提高这些儿童认知自我调节能力这一观点。相反，在大多数情况下，抽动似乎对认知表现影响不大。
