Sebla GOKCE, Canan YUSUFOĞLU, Elif AKIN, Muhammed AYAZ

Dikkat-eksikliği/hiperaktivite bozukluğu tanısı konan ergenlerde cinsiyet farklılıklarının dürtüsellik üzerine etkisi

Amaç: Dürtüsellik özellikle dikkat-eksikliği/hiperaktivite bozukluğunun (DEHB) ana belirti kümelerinden biri olarak kabul edilmektedir. Bu çalışmada DEHB tanısı konan ergenlerde cinsiyet farklılıklarının dürtüsellik üzerine etkilerinin araştırılması planlanmıştır. Yöntem: 01.01.2016-01.05.2016 tarihleri arasında Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi Çocuk ve Ergen Psikiyatri Polikliniği'nde DEHB tanısı konan 156 ergen (91 erkek, 65 kadın) bu araştırmanın örneklem grubunu oluşturmaktadır. Çalışmaya katılan ergenler Barratt Dürtüsellik Ölçeğini (BIS-11), anne-babalar SNAP DEHB Ölçeğini doldurmuşlardır. Bulgular: Katılımcıların %41.7'sı (s=65) kadın, %58.3'ü (s=91) erkektir. Kızların yaş ortalaması 14.3±1.7 yıl, erkeklerin yaş ortalaması 14.4±1.7 yıldır. BIS11 toplam dürtüsellik ortalama puanı, motor alt test dürtüsellik ortalama puanı ve dikkate bağlı dürtüsellik alt test ortalama puanı kadınlarda erkeklere göre anlamlı oranda daha yüksek bulunmuştur. Çoklu doğrusal regresyon analizinde bağımsız değişken olarak cinsiyet, toplam dürtüsellik, motor dürtüsellik, dikkate bağlı dürtüsellik puanı ile ilişkili bulunmuştur. Sonuç: Bu çalışmada DEHB'li kız ergenlerin BIS-11 ile ölçülen toplam dürtüsellik, motor dürtüsellik ve dikkate bağlı dürtüsellik puanları DEHB'li erkek ergenlere göre daha yüksek bulunmuştur. Önceki çalışmalarda cinsiyet ve dürtüsellik ilişkisi ile ilgili tutarlı sonuçlar bulunmamıştır. Bu çalışma klinik örneklemde kadın cinsiyetinde daha fazla dürtüsellik olduğunu gösteren çalışmaların sonuçlarını desteklemektedir.

Effect of gender differences on impulsivity in adolescents with attention-deficit/hyperactivity disorder

Objective: Impulsiveness has been considered the core symptom of attention-deficit/hyperactivity disorder (ADHD). In this study, we aimed to assess effect of gender differences on impulsivity in adolescents diagnosed with ADHD. Methods: One hundred and fifty-six adolescents (91 males, 65 females) who were admitted to the Erenköy Research and Training Hospital for Psychiatry and Neurology Child and Adolescent Clinic between 01.01.2016 and 01.05.2016 and diagnosed with ADHD were recruited to participate in this study. Adolescents filled out Barratt Impulsiveness Scale and parents completed the SNAP IV ADHD Scale. Results: Of the participants, 41.6% (n=65) were female and 58.3% (n=91) were male. The mean age of girls was 14.3±1.7 years, and the mean age of boys was 14.4±1.7 years. The Barratt impulsivity mean total scores, the Barratt attentive impulsivity subscale mean scores, and the Barratt motor impulsivity subscale mean scores were significantly higher in the female ADHD group than in the male ADHD group. In multiple linear regression analysis, gender was significantly correlated with the Barratt impulsivity total mean score, the Barratt attentive impulsivity mean score, and the Barratt motor impulsivity mean score. Conclusion: The finding of greatest interest in this analysis is that the adolescent girls who were diagnosed with ADHD had greater attentive and motor impulsivity scores than boys as measured by the BIS-11. Although, some previous research reported inconsistent findings of impulsivity levels by gender, our findings confirm prior reports of higher impulsivity in the female clinical population.

PDF

___

1. Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry 2001; 158:1783-1793.
2. Eysenck SB, Eysenck HJ. The place of impulsiveness in a dimensional system of personality description. Br J Soc Clin Psychol 1977; 16:57-68.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM). Washington, DC: American Psychiatric Association, 1994, p.143-147.
4. Winstanley CA, Eagle DM, Robbins TW. Behavioral models of impulsivity in relation to ADHD: translation between clinical and preclinical studies. Clin Psychol Rev 2006; 26:379-395.
5. Taylor E, Sonuga-Barke E. Disorders of attention and activity. M Rutter, DVM Bishop, DS Pine, S Scott, J Stevenson, E Taylor, A Thapar (Eds.), Rutter's Child and Adolescent Psychiatry, fifth ed., Oxford, UK: Blackwell, 2008, p.519-542.
6. Castellanos FX, Tannock R. Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes. Nat Rev Neurosci 2002; 3:617-628.
7. Biederman J. Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 2005; 57:1215-1220.
8. Brass M, von Cramon DY. The role of the frontal cortex in task preparation. Cereb Cortex 2002; 12:908-914.
9. Rubia K. The dynamic approach to neurodevelopmental psychiatric disorders: use of fMRI combined with neuropsychology to elucidate the dynamics of psychiatric disorders, exemplified in ADHD and schizophrenia. Behav Brain Res 2002; 130:47-56.
10. Berg JM, Latzman RD, Bliwise NG, Lilienfeld SO. Parsing the heterogeneity of impulsivity: A metaanalytic review of the behavioral implications of the UPPS for psychopathology. Psychol Assess 2015; 27:1129.
11. Arnett JJ. Reckless behavior in adolescence: A developmental perspective. Dev Rev 1992; 12:339-373.
12. Casey BJ, Getz S, Galvan A. The adolescent brain. Dev Neuropsychol 2008; 28:62-77.
13. Nelson CA, Bloom FE, Cameron JL, Amaral D, Dahl RE, Pine D. An integrative, multidisciplinary approach to the study of brain-behavior relations in the context of typical and atypical development. Dev Psychopathol 2002; 14:499-520.
14. Ernst M, Grant SJ, London ED, Contoreggi CS, Kimes AS, Spurgeon L. Decision making in adolescent with behavior disorders and adults with substance abuse. Am J Psychiatry 2003; 160:33-40.
15. Forbes EE, Christopher May J, Siegle GJ, Ladouceur CD, Ryan ND, Carter CS, et al. Reward- related decision-making in pediatric major depressive disorder: an fMRI study. J Child Psychol Psychiatry 2006; 47:1031-1040.
16. Rucklidge JJ, Tannock R. Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD. J Am Acad Child Adolesc Psychiatry 2001; 40:530-540.
17. Lejuez CW, Bornovalova MA, Reynolds EK, Daughters SB, Curtin JJ. Risk factors in the relationship between gender and crack/cocaine. Exp Clin Psychopharmacol 2007; 15:165-175.
18. Gulec H, Tamam L, Gulec MY, Turhan M, Karakus G, Zengin M, et al. Psychometric properties of the Turkish version of the Barratt Impulsiveness Scale-11. Bulletin of Clinical Psychopharmacology 2008; 18:251-258.
19. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 1999; 56:1073-1086.
20. Bussing R, Fernandez M, Harwood M, Hou W, Garvan CW, Eyberg SM, et al. Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms psychometric properties and normative ratings from a school district sample. Assessment 2008; 15:317-328.
21. Güler AS, Scahill L, Jeon S, Taşkın B, Dedeoğlu C, Ünal S, et al. Use of multiple informants to identify children at high risk for ADHD in Turkish school-age children. J Atten Disord 2014 May 5 [Epub ahead of print].
22. Speranza M, Revah-Levy A, Cortese S, Falissard B, Pham-Scottez A, Corcos M. ADHD in adolescents with borderline personality disorder. BMC Psychiatry 2011; 11:158.
23. Patton JH, Stanford MS. Factor structure of the Barratt impulsiveness scale. J Clin Psychol 1995; 51:768-774.
24. Bechara A, Damasio H, Damasio AR. Emotion, decision making and the orbitofrontal cortex. Cereb Cortex 2000; 10:295-307.
25. Petrovic P, Castellanos FX. Top-down dysregulation-from ADHD to emotional instability. Frontiers in Behavioral Neuroscience 2016; 10:70.
26. Johnson SL, Carver CS, Tharp JA. Suicidality in bipolar disorder: the role of emotion-triggered impulsivity. suicide and life-threatening behavior. 2016 [Epub ahead of print].
27. Auerbach RP, Stewart JG, Johnson SL. Impulsivity and suicidality in adolescent inpatients. J Abnorm Child Psychol 2016; 44:1-13.
28. Beautrais AL. Suicide and serious suicide attempts in youth: a multiple-group comparison study. Am J Psychiatry 2003; 160:1093-1099.
29. Lewinsohn PM, Rohde P, Seeley JR, Baldwin CL. Gender differences in suicide attempts from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry 2001; 40:427-434.
30. Witte TK, Merrill KA, Stellrecht NE, Bernert RA, Hollar DL, Schatschneider C, et al. "Impulsive" youth suicide attempters are not necessarily all that impulsive. J Affect Disord 2008; 107:107-116.
31. Ottosen C, Petersen L, Larsen JT, Dalsgaard S. Gender differences in associations between attention-deficit/hyperactivity disorder and substance use disorder. J Am Acad Child Adolesc Psychiatry 2016; 55:227-234.
32. Gabel S, Schmitz S, Fulker DW. Comorbidity in hyperactive children: issues related to selection bias, gender, severity, and internalizing symptoms. Child Psychiatry Hum Dev 1996; 27:15-28.
33. Levy F, Hay DA, Bennett KS, McStephen M. Gender differences in ADHD subtype comorbidity. J Am Acad Child Adolesc Psychiatry 2005; 44:368-376.
34. Fields S, Sabet M, Peal A, Reynolds B. Relationship between weight status and delay discounting in a sample of adolescent cigarette smokers. Behav Pharmacol 2011; 22:266.
35. Marazziti D, Baroni S, Masala I, Golia F, Consoli G, Massimetti G, et al. Impulsivity, gender, and the platelet serotonin transporter in healthy subjects. Neuropsychiatr Dis Treat 2010; 6:9-15.
36. Stoltenberg SF, Batien BD, Birgenheir DG. Does gender moderate associations among impulsivity and health-risk behaviors? Addict Behav 2008; 33:252-265.
37. Lage GM, Albuquerque MR, Fuentes D, Correa H, Malloy-Diniz LF. Sex differences in dimensions of impulsivity in a non-clinical sample. Percept Mot Skills 2013; 117:601-607.
38. Reynolds B, Ortengren A, Richards JB, de Wit H. Dimensions of impulsive behavior: Personality and behavioral measures. Pers Indiv Differ 2006; 40:305-315.
39. Biederman J, Faraone SV. The Massachusetts General Hospital studies of gender influences on attention-deficit/hyperactivity disorder in youth and relatives. Psychiatr Clin North Am 2004; 27:225-232.
40. Barkley RA, Fischer M. The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. J Am Acad Child Adolesc Psychiatry 2010; 49:503- 513.
41. Ünsel Bolat G, Ercan ES, Salum GA, Bilaç Ö, Massuti R, Özaslan TU, et al. Validity of proposed DSM-5 ADHD impulsivity symptoms in children. Eur Child Adolesc Psychiatry 2016; 25:1121- 1132.