Okul çağı çocuklarında gelişimsel kekemelik ve eşlik eden psikiyatrik bozukluklar

Amaç: Araştırmalar psikiyatrik sorunlarla kekemeliğin ortak nörofizyolojik nedenlerle veya kekemeliğin neden olduğu ruhsal-toplumsal güçlükler nedeniyle birlikte görülebileceğini öne sürmüştür. Bu çalışmanın amacı, okul çağı çocuklarından oluşan klinik örneklemde kekemeliğe eşlik eden psikiyatrik bozuklukları değerlendirmek, psikiyatrik eş tanısı olan ve olmayan kekemelik hastalarını yaş, cinsiyet ve kekemelik şiddeti açısından karşılaştırmaktır. Yöntem: Bu çalışma kesitsel, geriye dönük bir çalışma olup elektronik ortamda kayıtlı poliklinik kayıtları üzerinde yapılan inceleme neticesinde kekemelik tanısı konmuş 6-12 yaşları arasındaki 89 çocuk ile gerçekleştirilmiştir. Kekemelik tanısı DSM-5 çocukluk başlangıçlı konuşma akıcılığı bozukluğu (kekemelik) tanı ölçütlerine göre konulmuştur. Kekemelik şiddetinin değerlendirilmesinde Klinik Global İzlenim Ölçeği kullanılmıştır. Katılımcıların psikiyatrik değerlendirmesi Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam Boyu Şekli ile yapılmıştır. Bulgular: Katılımcıların %51.7’sinde psikiyatrik eş tanı saptanmıştır. Belirlenen psikiyatrik eş tanılar sırasıyla %30.3 dikkat eksikliği ve hiperaktivite bozukluğu, %12.4 sosyal anksiyete bozukluğu ve %4.5 özgül öğrenme bozukluğu şeklindedir. Çalışmada katılımcılar psikiyatrik eş tanısı olan ve olmayanlar şeklinde iki gruba ayrılarak yaş, cinsiyet ve kekemelik şiddeti açısından karşılaştırılmıştır. Yapılan analizde psikiyatrik eş tanının erkeklerde (%56) kızlara (%23) göre anlamlı oranda yüksek olduğu, psikiyatrik eş tanısı olanların yaş ortalamasının (8.06) psikiyatrik eş tanısı olmayanlardan (7.16) anlamlı oranda yüksek olduğu saptanmıştır. Kekemelik şiddetine göre yapılan incelemede ise gruplar arasında anlamlı farklılık saptanmamıştır. Tartışma: Çalışmamızın sonuçları psikiyatrik bozuklukların kekemeliği olan okul çağı çocuklarında, iki çocuktan birinde kekemeliğe eşlik ettiğini ortaya koymuştur. Kekemelikte psikiyatrik eş tanı varlığının kekemelik tedavisindeki olumsuz etkilerine vurgu yapan alan yazın bilgileri göz önünde bulundurulduğunda, kekemelikte psikiyatrik eş tanının belirlenmesinin ve yapılacak müdahalelerin gerek kekemelik tedavisi ile ilgilenen profesyonellere, gerekse tedavi gören hastalara fayda sağlayacağı düşüncesindeyiz. (Anadolu Psikiyatri Derg 2020; 21(5):523-530)

Developmental stuttering and comorbid psychiatric disorders in school age children

Objective: Previous researches suggested that psychiatric problems and stuttering may be associated with common neurophysiological reasons or because of the social and psychological difficulties caused by stuttering. The aim of this study was to evaluate comorbid psychiatric disorders in school age children with stuttering and to compare stuttering patients with and without psychiatric comorbidity in terms of age, gender and stuttering severity. Methods: This is a cross-sectional, retrospective study and the study was conducted with 89 children aged 6-12 years who were diagnosed as stuttering. Diagnosis of developmental stuttering was established by child psychiat-rists based on DSM-5 childhood-onset speech fluency disorder (stuttering) diagnostic criteria. The Clinical Global Impression Scale was used to assess the severity of stuttering. The psychiatric evaluation of the participants was conducted with Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Results: The rate of comorbid psychiatric disorders in school-aged children with stuttering was 51.7%. The comorbid psychiatric disorders were attention deficit and hyperactivity disorder (30.3%), social anxiety disorder (12.4%) and specific learning disorder (4.5%). The participants were divided into two groups according to the presence or absence of psychiatric comorbidity and compared in terms of age, gender and stuttering severity. The results showed that psychiatric comorbidity was significantly higher in boys (56%) than girls (23%), and the mean age of those with psychiatric comorbidity (8.06) was significantly higher than those without psychiatric comorbidity (7.16). There was no significant difference between the groups in terms of stuttering severity. Discussion: The results of this study revealed that one of two children in school age children with stuttering had a comorbid psychiatric disorder. Considering the literature data emphasizing the negative effects of psychiatric comorbidity in stuttering especially on stuttering treatment, we think that determination of psychiatric comorbidity and interventions will provide important benefits for both professionals and patients. (Anatolian Journal of Psychiatry 2020; 21(5):523-530)

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