Department of Child- and Adolescence Psychiatry, Neurology, Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany.
World J Biol Psychiatry. 2011 Sep;12 Suppl 1:35-9. doi: 10.3109/15622975.2011.600354.
If the cardinal symptoms of ADHD - hyperactivity, impulsivity and inattention - are combined with a learning disability (70 ≥ IQ < 85), the question arises whether a child shows hyperkinetic behaviour because of intellectual overload in a challenging situation, for example at school. Perhaps, this behaviour is not a primary attention deficit disorder but an impulse control disorder, determined by the primarily intelligence level. It raised the question whether attention deficit and impulse control regarded as behavioural inhibition deficit may depend on intelligence and therefore should be separated into distinct clinical entities.
A total of 45 children (15 with ADHD, 15 with learning disabilities (LD), 15 with ADHD and learning disabilities) were compared in a matched-pair design with 42 control children using a go/no go paradigm (visual continuous performance test, CPT). The dependent variable was the target P3 amplitude, averaged from a 10-20 EEG measurements under distinct trigger conditions. For statistical analysis, a three-factor analysis of variance (MANOVA) with repeated measurements was used. In a subsequent regression analysis with residuals, the influence of intelligence (IQ) was calculated and a "parallel analysis of variance" was conducted.
No differences in the P3 amplitudes in the comparison ADHD-control group were found. Reduced P3 amplitudes as main effects in the LD group compared with controls were found and a significant group-dependent interaction on reduced P3 amplitudes comparing ADHD + LD versus control group. Using residuals (IQ), this interaction was not longer verifiable.
Impulsivity and attention deficit as the cardinal symptoms of ADHD, regarded as behavioural inhibition deficit, are essentially moderated by the primary intelligence, rather than by an attention deficit. The lower the IQ, the more ADHD surfaces as a disturbed impulsivity and lesser as an attention deficit.
如果 ADHD 的主要症状（多动、冲动和注意力不集中）伴有学习障碍（70≥智商<85），那么就会出现这样一个问题，即孩子在具有挑战性的情况下（例如在学校）是否因为智力负荷过大而表现出多动行为。也许，这种行为不是原发性注意缺陷障碍，而是冲动控制障碍，由主要智力水平决定。这就提出了一个问题，即注意力缺陷和冲动控制是否被视为行为抑制缺陷，可能取决于智力，因此应该分为不同的临床实体。
采用匹配对设计，共有 45 名儿童（15 名 ADHD 儿童、15 名学习障碍儿童、15 名 ADHD 和学习障碍儿童）与 42 名对照儿童进行比较，使用 Go/No-go 范式（视觉连续性能测试，CPT）。因变量为在不同触发条件下进行 10-20 次 EEG 测量后平均得到的目标 P3 振幅。为了进行统计分析，采用了具有重复测量的三因素方差分析（MANOVA）。在随后的残差回归分析中，计算了智力（智商）的影响，并进行了“方差平行分析”。
ADHD 对照组之间的 P3 振幅无差异。与对照组相比，LD 组的 P3 振幅明显降低，且 ADHD+LD 组与对照组相比 P3 振幅显著降低。使用残差（智商），这种相互作用不再是可验证的。
作为 ADHD 的主要症状的冲动性和注意力缺陷，被认为是行为抑制缺陷，本质上是由主要智力调节的，而不是由注意力缺陷调节的。智商越低，ADHD 表现为多动障碍的可能性越大，而注意力缺陷的可能性越小。
