A. Şebnem SOYSAL, Ayşegül YILDIRIM, Aktan ACAR, BAŞAK KARATEKE, KIZBES MERAL KILIÇ

Dikkat eksikliği hiperaktivite bozukluğu alt tiplerinin aile işlevleri üzerindeki etkisi

Amaç: Dikkat eksikliği hiperaktivite bozukluğu (DEHB), bireyi olduğu kadar ailesini de ciddi boyutlarda etkileyen bir ruhsal bozukluktur. Bu çalışmanın amacı, bilişsel-sosyal işlev düzeyinde belirgin bir bozulması olmayan DEHB’lilerin aile işlevselliğini değerlendirmektir. Yöntem: Bu çalışmada, yaşları 6-10 arasında değişen 27 dikkat eksikliği alt tipi (DEHB-DE), 18 hiperaktivite/ dürtüsellik alt tipi (DEHB-HD), 32 bileşik alt tipi (DEHB-B) tanılı hasta ve kontrol için yer alan 35 katılımcı ve anneleri değerlendirilmiştir. Veriler, Wechsler Çocuklar İçin Zeka Ölçeği, Conners Anne/Baba ve Öğretmen Derecelendirme Ölçekleri ve Aile Değerlendirme Ölçeği (ADÖ) kullanılarak toplanmıştır. Sonuçlar: ADÖ alt testlerine ilişkin ortalama ve standart sapma değerleri incelendiğinde, problem çözme davranışı açısından DEHB-HD, iletişim alt testinde DEHB-DE, roller alt testinde DEHB-B, gereken ilgiyi gösterme Address reprint requests to / Yazışma adresi: Assoc. Prof. Dr. A. Şebnem Soysal, Gazi Unversity Faculty of Medicine Department of Pediatrics, Beşevler, Ankara - Turkey Phone / Telefon: +90-312-202-6002 alt testinde DEHB-DE, DEHB-HD ve genel işlevler açısından da DEHB-HD alt tipinde yer alan katılımcıların yüksek Fax / Faks: +90-312-215-0143 puanlar aldıkları görülmüştür. ADÖ’ye ilişkin yapılan tek yönlü varyans analizi sonucunda da davranış kontrolü E-mail address / Elektronik posta adresi: assoysal@gazi.edu.tr alt ölçeği dışındaki ölçeklerde, gruplar arasında fark olduğu belirlenmiştir. Tartışma: DEHB olguları değerlendirilirken sağaltım girişimlerinde, çocuğun yanı sıra aile de değerlendirilmeli, aile dinamiklerinin tedavi süreci üzerindeki etkinliği irdelenmelidir. Böylece çocuğun problem çözme, sosyal yargılama, duygusal tepki verebilme gibi sosyal yaşama uyum becerileri artırılmış olacaktır.

Effects of attention deficit and hyperacitivity disorder subtypes on family functions

Objective: Attention deficiency and hyperactivity disorder (ADHD) is a mental disorder that seriously affects both the individual and his/her family. The aim of this study is to evaluate family functions of individuals with different subtypes of ADHD who have no significant cognitive and social impairments. Methods: 27, 18, and 32 subjects with ADHD-inattentive (ADHD-I), ADHD-hyperactivity-impulsivity (ADHD-HI) and ADHD-combined (ADHD-C) subtypes, respectively, and 35 control subjects aged 6 to 10 years and their mothers were included in the study. Wechsler Intelligence Scale For Children, Conners Parent And Teacher Rating Scales and Family Assessment Scale (FAS) were used. Results: FAS subtests indicated that problem solving score of ADHD-HI subgroup, communication score of ADHD-I subgroup, roles score of ADHD-C subgroup, “showing necessary interest” scores of ADHD-I and ADHD- HI subgroups, and general functioning scors of ADHD-HI subgroup were higher than the other subgroups. ANOVA results indicated that FAS subtest scores, other than behavior control score, were significantly different among subgroups. Discussion: Assessment of ADHD treatment efficiency should include, not only the child, but also the family and family dynamics. Therefore, social adaptation skills -such as problem solving, social evaluation and emotional reactions of the individuals with ADHD- will be increased.

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1. Biederman J. Attention-deficit/hyperactiviy disorder: a selective overview. Biol Psychiatry 2005; 57:1215-1220.
2. Epstein NB, Bolwin LM, Bishop DS. The Mcmaster family assessment device. J Marital Fam Ther 1983; 9:171-180.
3. Biederman, J, Faraone, SV. Attention-deficit hyperactivity disorder. Lancet 2005; 366:237-248.
4. Kilic BG, Sener S. Family functioning and psychosocial characteristics in children with attention deficit hyperactivity disorder with comorbid oppositional defiant disorder or conduct disorder. Turk Psikiyatri Derg 2005; 16:21-28 (in Turkish).
5. Mash EJ, Johnston C. Parental perception of child behavior problems, parenting, self-esteem, and mother’s reported stress in younger and older hyperactives and normal children. J Consult Clin Psychol 1983; 51:86-99.
6. Hetchman L. Families of Hyperactives: In Greeney J (editor). Research in Community and Mental Health. JAI Pres: Greenwich CT, 1981; 275-292.
7. Satterfield JH, Satterfield BI, Schell AE. Therapeutic intervention to prevent delinquency in hyperactive boys. J Am Acad Child Adolesc Psychiatry 1987; 26:56-64.
8. DuPaul GJ, Barkley RA. Situational variability of attention problems: psychometric properties of the revised home and school stations questionnaires. J Clin Child Adolesc Psychol 1992; 21:178-188.
9. Seidman LJ, Biederman J, Faraone SV, Weber W, Ouellette C. Toward defining a neuropsychology of attention deficithyperactivity disorder: performance of children and adolescents from a large clinically referred sample. J Consult Clin Psychol 1997; 65:150-160.
10. Barkley RA. Behavioral inhibition, sustained attention and executive functions: constructing a unifying theory of ADHD. Psychol Bull 1997; 121:65-94.
11. Nigg JT. Neuropsychology theory and findings in attentiondeficit/ hyperactivity disorder: the state of the field and salient challenges for the coming decade. Biol Psychiatry 2005; 57:1424- 1435.
12. Scahill L, Schwab-Stone M, Merikangas KR, Leckman JF, Zhang H, Kasl S. Psychosocial and clinical correlates of ADHD in a community sample of school age children. J Am Acad Child Adolesc Psychiatry 1999; 38:976-984.
13. Pekcanlar A, Turgay A, Miral S. Family functioning in attention deficit hyperactivity disorder. Turkish Journal of Child and Adolescent Mental Health 1999; 6:99-107 (in Turkish).
14. Kuntsi J, Oosterlaan J, Stevenson J. Psychological mechanisms in hyperactivity: response inhibition deficit, working memory impairment, delay aversion, or something else? J Child Psychiatry 2001; 42:199-210.
15. Senol S, Sener S. Dikkat Eksikliği Hiperaktivite Bozukluğu: İçinde Güleç C, Köroğlu E (editörler). Psikiyatri Temel Kitabı. Ankara: Hekimler Yayın Birliği, 1999, 1119-1130 (Book in Turkish).
16. Ozcan E, Egri M, Kutlu O, Yakinci C, Karabiber H, Genc M. ADHD prevalence among school-age children: a preliminary study. Journal of Turgut Ozal Medical Center 1998; 5:138-142 (in Turkish).
17. Savasir I, Sahin N. Wechsler Çocuklar İçin Zeka Ölçeği (WISC-R) El Kitabı. Türk Psikologlar Derneği Yayınları, Ankara, 1995, 13-52 (Book in Turkish).
18. Dereboy C, Senol S, Sener S, Dereboy IF. Conners Ana Baba Derecelendirme Ölçeği uyarlama çalışması. 10.Ulusal Psikoloji Kongre Özet Kitabı 1998 (Book in Turkish).
19. Bulut I. Aile değerlendirme ölçeği (ADÖ) elkitabı. Özgüzeliş Matbaası. Ankara, 1990 (Book in Turkish).
20. Barkley, RA. Genetics of childhood disorders: the executive functions and ADHD. J Am Acad Child Adolesc Psychiatry 2000; 39:1064-1068.
21. Biederman J, Faraone SV, Keenan K, Benjamin J, Krifcher B, Moore C, Sprich-Buckminster S, Ugaglia K, Jellinek MS, Steingard R. Further evidence for family genetic risk factors in attention deficit hyperactivity disorder: patterns of comorbidity in probands and relatives in psychiatrically and pediatrically referred samples. Arch Gen Psychiatry 1992; 49:728-738.
22. Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P. Molecular genetics of attention-deficit/ hyperactivity disorder. Biol Psychiatry 2005; 57:1313-1323.
23. Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E, Ablon S, Warburton R, Reed E. Family-environment risk factors for attention-deficit hyperactivity disorder: a test of Rutter’s indicators of adversity. Arch of Gen Psych 1995; 52:464-470.
24. Diagnostic And Statistical Manual Of Mental Disorders. American Psychiatric Association. Fourth ed., Washington DC: APB Pres, 1994; 55-57.
25. Morgan MA. Attention Deficit Hyperactivity Disorder. Pediatric Clinics of North America. Washington: Saunders Company, 1998; 5:871-884.
26. Faraone SV, Biederman J, Weber W, Russell R. Psychiatric, Neuropsychological and Psychosocial Features of DSMIV Subtypes Of Attention-Deficit/Hyperactivity Disorder: In Charney DS, Nestler ES, Bunney BS (editors). Neurobiology of Mental Illness. Oxford University Pres, 1998; 788-801.
27. Biederman J, Faraone SV, Taylor A. Diagnostic continuity between child and adolescent ADHD: finding from a longitudinal clinical sample. J Am Acad Child Adolesc Psychiatry 1998; 37:305-313.
28. Lee DO, Ousley OY. Attention-deficit hyperactivity disorder symptoms in a clinic sample of children and adolescents with pervasive developmental disorders. J Child Adolesc Psychopharmacol 2006; 16:737-746.
29. Conners CK. Rating scales in attention-deficit/hyperactivity disorder: use in assessment and treatment monitoring. J Clin Psychiatry 1998; 59:24-30.
30. Fettahoglu C, Ozatalay E. Hyperactivity and/or attention problems and attention deficit and hyperactivity disorder in children. Turkish Journal of Child and Adolescent Mental Health 2006; 13:13-18 (in Turkish).
31. Shaywitz SE, Shaywitz BA. Attention deficit disorder: current perspectives. J Pediatr Neurol 1987; 3:129-35.
32. Friedmann MS, McDermut WH, Solomon DA, Ryan CE, Keitner GI, Miller IW. Family functioning and mental illness: a comparison of psychiatric and nonclinical families. Fam Process 1997; 36:357-367.
33. Gulseren L, Coskun S, Gulseren S. A comparative study on family functioning of schizophrenia and bipolar disorder patients and their families. 3P 1999; 7:23-32 (in Turkish).
34. Bulut I. Ruh Hastalığının Aile İşlevlerine Etkisi. Başbakanlık Kadın ve Sosyal Hizmet Müsteşarlığı Yayınları, Ankara, 1993 (Book in Turkish).
35. Soysal AS. Examination of the relationship pattern formed by attention, executive functions, and meta-cognitive performance among the subtypes of attention deficit hyperactivity disorder. Doktora Tezi, Hacettepe University Graduate School of Social Sciences , Ankara, 2007 (Thesis in Turkish).
36. Hoza B, Owens JS, Pelham WE, Swanson JM, Conners KC, Hinshaw SP, Arnold EL, Kraemer HC. Effect of parent cognitions on child treatment response in attention deficit/hyperactivity disorder. J Abnorm Child Psychol 2000; 28:569-583.