Amaç: Dikkat eksikliği hiperaktivite bozukluğu (DEHB) ve kaygı bozuklukları çocuk psikiyatrisi alanında sıklıkla görülen bozukluklardır. Çocukluk çağında DEHBye kaygı bozukluklarının eşlik etme oranı %13-50 arasında değişmektedir. Bu çalışmada DEHB tanısı alan çocuklarda kaygı belirtilerinin araştırılması, bu belirtilerin DEHB belirtileri ile ilişkisinin değerlendirilmesi ve sağlıklı kontrollerle karşılaştırılması amaçlandı. Yöntem: Çalışmaya DEHB tanısı almış 8-16 yaş arası 50 çocuk ve herhangi bir ruhsal bozukluk tanısı almayan 48 sağlıklı kontrol dahil edildi. Katılımcıların değerlendirilmesinde sosyodemografik bilgi formu, Conners Öğretmen Derecelendirme Ölçeği (CÖDÖ), Çocukluk Çağı Anksiyete Tarama Ölçeği (ÇATÖ) (Ebeveyn ve Çocuk Formu) ve 4-18 Yaş Çocuk ve Gençlerde Davranış Değerlendirme Ölçeği (ÇDDÖ) kullanıldı. Tanılar Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi- Şimdi ve Yaşam Boyu Şekli (ÇDŞG-ŞY) ile konuldu.Bulgular: DEHB grubunun %24ünde kaygı bozukluğu eş tanısı saptandı. DEHB grubunda, ÇATÖ ebeveyn ve ÇATÖ çocuk formu toplam puan ortalamalarının kontrol grubundan daha yüksek olduğu belirlendi. Her iki grupta, ÇATÖ çocuk formu puanları ÇATÖ ebeveyn formu puanlarına göre daha yüksek bulundu. Tartışma: Bu çalışmanın sonuçları kaygı belirtilerinin DEHBye sıklıkla eşlik ettiğini ve kaygı belirtilerinin dikkat eksikliği belirtileri ile ilişkili olduğunu doğrulamaktadır. Çalışmamızda, ebeveynler çocukların öz bildirimine kıyasla çocuklarında daha az kaygı belirtisi bildirmişlerdir. DEHBli çocuk ve ergenlerde ebeveynleri tarafından atlanabilen kaygı belirtileri klinisyenler tarafından sorgulanmalı ve eş tanı varlığı tespit edilip tedavi yaklaşımları buna göre belirlenmelidir.
Objective: Attention deficit hyperactivity disorder (ADHD) and anxiety disorders are commonly seen in the field of child psychiatry. Childhood ADHD and anxiety disorders are comorbid with an estimated rate of 13% to 50%. In this study, it was aimed to research anxiety symptoms and its relation with ADHD symptoms in children with ADHD. Method: Fifty children with ADHD and 49 healthy controls (aged 8-15 years) who do not have any psychiatric diagnosis were included in study. We used socio-demographic information form, Conners Teacher Rating Scale (CTRS), Child Behavior Checklist for 4-18 years (CBCL), The Screen for Child Anxiety Related Emotional Disorders (SCARED) both parent and child report for assessing these children. The diagnosis were made with Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL). Results: The anxiety disorders comorbidity rate was 24% in ADHD group. The total scores of SCARED parent and children reports were higher in ADHD group. SCARED children report scores were higher than SCARED parent report scores in both groups. Discussion: Our results agree with the previously reported common anxiety comorbidity with ADHD and the association between attention deficit symptoms and anxiety symptoms. In our study, parents reported fewer anxiety symptoms in their children than childrens self reports. Clinicians should evaluate anxiety symptoms carefully in children with ADHD that could be unnoticed by their parents. The treatment should be determined according to the comorbidities.
1. Faraone S, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2003; 2:104-113.
2. Polanczyk G, De Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: A systematic review and metaregression analysis. Am J Psychiatry 2007; 164:942-948.
3. Biederman J. Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 2005; 57:1215-1220.
4. August GJ, Realmuto GM, MacDonald AW 3rd, Nugent SM, Crosby R. Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior. J Abnorm Child Psychol 1996; 24:571-595.
5. Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E, Ablon SJ, Warburton R, Reed E, Davis SG. Impact of adversity on functioning and comorbidity in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1995; 34:1495-1503.
6. Biederman J, Faraone SV, Keenan K, Steingard R, Tsuang MT. Familial association between attention deficit disorder and anxiety disorders. Am J Psychiatry 1991; 148:251-256.
7. Braaten EB, Biederman J, Monuteaux MC, Mick E, Calhoun E, Cattan G, Faraone SV. Revisiting the association between attention-deficit/hyperactivity disorder and anxiety disorders: a familial risk analysis. Biol Psychiatry 2003; 53:93-99.
8. Monga S, Birmaher B, Chiappetta L, Brent D, Kaufman J, Bridge J, Cully M. Screen for Child Anxiety-Related Emotional Disorders (SCARED): convergent and divergent validity. Depress Anxiety 2000; 12:85-91.
9. Hammerness P, Geller D, Petty C, Lamb A, Bristol E, Biederman J. Does ADHD moderate the manifestation of anxiety disorders in children? Eur Child Adolesc Psychiatry 2010; 19:107-112.
10. Conners CK. A teacher rating scale for use in drug studies with children. Am J Psychiatry 1969; 126:884-888.
11. Conners CK. Rating scales for use in drug studies with children. Psychopharmacol Bull 1973; 9(Special Issue):24-84.
12. Sener S, Dereboy C, Dereboy IF, Sertcan Y. Conners Teacher Rating Scale Turkish Version-1. Turkish Journal of Child and Adolescent Mental Health 1995; 2:131-141. (Turkish)
13. Dereboy C, Sener S, Dereboy IF, Sertcan Y. Conners Teacher Rating Scale Turkish Version-II. Turkish Journal of Child and Adolescent Mental Health 1997; 4:10-18. (Turkish)
14. Dereboy C, Senol S, Sener S, Dereboy F. Validation of the Turkish versions of the short-form Conners teacher and parent rating scales. Turk Psikiyatri Derg 2007; 18:48-58. (Turkish)
15. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, Neer SM. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 1997; 36:545-553.
16. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 1999; 38:1230-1236.
17. Cakmakci FK. Validation of the Anxiety Disorders Screening Scale for Children. Unpublished Masters Thesis, Kocaeli University, Faculty of Medicine, Department of Child Psychiatry, Kocaeli, 2004. (Turkish)
18. Achenbach TM, Edelbrock C. Manual for the Child Behavior Checklist/4-18 and Revised Child Behavior Profile. Burlington: University of Vermont, Department of Psychiatry, 1983.
19. Erol N, Simsek Z. Mental health among children and adolescents: distribution of problems associated with fields of skills, behaviors and emotions. In: Erol N, Kilic C, Ulusoy M, Kececi M, Simsek Z (editors). Mental Health Profile Report of Turkey. First Ed., Ankara: Eksek Tanitim Ltd. Sti., 1998, 25-75. (Turkish)
20. Akcakin M. Introduction and validity of behavioral assessment scale for children. Turk Psikoloji Dergisi 1985; 5:3-6. (Turkish)
21. Erol N, Arslan BL, Akcakin M. The adaptation and standardization of the Child Behavior Checklist among 6-18 year old Turkish children. In: Sergeant J (editor). Eunethdis: European Approaches to Hyperkinetic Disorder. Zürih: Fotoratar, 1995, 97-113.
22. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N. Externalizing initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36:980-988.
23. Gokler B, Unal F, Pehlivanturk B, Kultur EC, Akdemir D, Taner Y. Reliability and Validity of Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL-T). Turk J Child Adolesc Ment Health 2004; 11:109-116. (Turkish)
24. Pliszka, SR, Carlson CL, Swanson JM. ADHD With Comorbid Disorders: Clinical Assessment And Management. New York: The Guilford Press, 1999, 150-162.
25. Greene RW, Biederman J, Faraone SV, Monuteaux MC, Mick E, DuPre EP, Fine CS, Goring JC. Social impairment in girls with ADHD: patterns, gender comparisons, and correlates. J Am Acad Child Adolesc Psychiatry 2001; 40:704-710.
26. Volk HE, Neuman RJ, Todd RD. A systematic evaluation of ADHD and comorbid psychopathology in a population-based twin sample. J Am Acad Child Adolesc Psychiatry 2005; 44:768-775.
27. Connor DF, Steeber J, McBurnett K. A review of attention- deficit/hyperactivity disorder complicated by symptoms of oppositional defiant disorder or conduct disorder. J Dev Behav Pediatr 2010; 31:427-440.
28. MTA Cooperative Group. Moderators and mediators of treatment response for children with ADHD. Arch Gen Psychiatry 1999; 56:1088-1096.
29. Diamond IR, Tannock R, Schachar RJ. Response to methylphenidate in children with ADHD and comorbid anxiety. J Am Acad Child Adolesc Psychiatry 1999; 38:402-409.
30. Tannock R, Ickowicz A, Schachar R. Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry 1995; 34:886-896.
31. Hammerness P, Geller D, Petty C, Lamb A, Bristol E, Biederman J. Does ADHD moderate the manifestation of anxiety disorders in children? Eur Child Adolesc Psychiatry 2010; 19:107-112.
32. Cosi S, Canals J, Hernández-Martinez C, Vigil-Colet A. Parent child agreement in SCARED and its relationship to anxiety symptoms. J Anxiety Disord 2010; 24:129-133.
33. Bowen R, Chavira DA, Bailey K, Stein MT, Stein MB. Nature of anxiety comorbid with attention deficit hyperactivity disorder in children from a pediatric primary care setting. Psychiatry Res 2008; 157:201-209.
34. Mennin D, Biederman J, Mick E, Faraone SV. Towards defining a meaningful anxiety phenotype for research in ADHD children. J Atten Disord 2000; 3:192-199.
35. Jarret MA, Ollendick TH. A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: Implications for future research and practice. Clin Psychol Rev 2008; 28:1266-1280.
36. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington DC: American Psychiatric Association, 1994.
37. Gaub M, Carlson CL. Gender differences in ADHD: a meta- analysis and critical review. J Am Acad Child Adolesc Psychiatry 1997; 36:1036-1045.
38. Biederman J, Faraone SV, Keenan K, Benjamin J, Krifcher B, Moore C, Sprich-Buckminster S, Ugaglia K, Jellinek MS, Steingard R, Spencer T, Norman D, Kolodny R, Kraus I, Perrin J, Keller MB, Tsuang MT. 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.
39. Faraone SV, Biederman J, Mick E, Doyle AE, Wilens T, Spencer T, Frazier E, Mullen K. A family study of psychiatric comorbidity in girls and boys with attention-deficit/hyperactivity disorder. Biol Psychiatry 2001; 50:586-592.
40. Muris P, Merckelbach H, Van Brakel A, Mayer AB. The revised version of the screen for child anxiety related emotional disorders (SCARED-R): further evidence for its reliability and validity. Anxiety Stress Coping 1999; 12:411-425.
41. Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A. A parent-report measure of childrens anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther 2004; 42: 813-839.
42. Monga S, Birmaher B, Chiappetta L, Brent D, Kaufman J, Bridge J, Cully M. Screen for Child Anxiety-Related Emotional Disorders (SCARED): convergent and divergent validity. Depress Anxiety 2000; 12:85-91.
43. Weiss M, Worling D, Wasdell M. A chart review study of the inattentive and combined types of ADHD. J Atten Disord 2003; 7:1-9.
44. Maedgen JW, Carlson CL. Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. J Clin Child Psychol 2000; 29:30-42.
45. Carlson CL, Mann M. Attention-deficit/hyperactivity disorder, predominantly inattentive subtype. Child Adolesc Psychiatr Clin N Am 2000; 9:499-510.
46. Grizenko N, Paci M, Joober R. Is the inattentive subtype of ADHD different from the combined/hyperactive subtype? J Atten Disord 2010; 13:649-657.
47. Fis N, Kayan E, Murat D. Poyraz OT, Irmak MY, Buyukdeniz A, Arman A. Distribution of anxiety symptoms among the subtypes of Attention Deficit Hyperactivity Disorder. 22th National Child and Adolescent Mental Health Congress (24-27th of April, 2012). Book of Abstracts. Bolu: 2012, 84-85. (Turkish)
48. Baldwin JS, Dadds MR. Examining alternative explanations of the covariation of ADHD and anxiety symptoms in children: a community study. J Abnorm Child Psychol 2008; 36:67- 79.
49. Martin A, Volkmar FR. Lewiss Child and Adolescent Psychiatry: A Comprehensive Textbook. Fourth Ed. Philadelphia: Lippincott Williams & Wilkins, 2007, 439.
50. Lemstra M, Neudorf C, DArcy C, Kunst A, Warren LM, Bennett NR. A systematic review of depressed mood and anxiety by SES in youth aged 10-15 years. Can J Public Health 2008; 99:125-129.