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Yıl:1999; Cilt: 6; Sayı: 1>> Özet
Çocuk ve Gençlik Ruh Sağlığı Dergisi; 1999;6(1):12-18
Dikkat Eksikliği Hiperaktivite Bozukluğu Olan Çocuk ve Gençlerde Komorbidite: Yaş ve Cinsiyet Farklılıkları
Ö Erman, A Turgay, B Öncü, V Urdarivic
İmge Ruh Sağlığı ve Danışma Merkezi, Ankara
Amaç: Bu çalışmada dikkat eksikliği hiperaktivite bozukluğu (DEHB) tanısı konmuş olan çocuk ve gençlerde komorbid psikiyatrik bozukluklar ve yaş ve cinsiyetin komorbidite üzerindeki etkisi incelenmiştir. Yöntem: Çocuk hekimleri ya da aile hekimleri tarafından DEHB ön tanısı ile Scarborough Hastanesi DEHB Tedavi, Eğitim ve Araştırma Enstitüsüne gönderilen ve DSM-IV ölçütlerine göre DEHB tanısı konulmuş olan 137 olgu çalışmaya alınmıştır. DEHB olgularında DSM-IV ölçütlerine göre belirlenen komorbid tanıların sıklığı ve bu tanıların yaş ve cinsiyete göre dağılımı araştırılmıştır. Bulgular: Olguların %29'unda komorbid bir psikiyatrik bozukluk belirlenmezken, %35'inde bir komorbid bozukluk, %25.5'inde iki komorbid bozukluk,%8'inde üç komorbid bozukluk vardır. Erkeklerde en sık komorbid bozukluk karşı gelme bozukluğudur (%62.3). Bunu davranım bozukluğu (%30.2), iletişim bozuklukları (%11.3), duygudurum bozuklukları (%7.5) ve anksiyete bozuklukları (%%6.6) izlemektedir. Kızlarda karşı gelme bozukluğu (%54.8), davranım bozukluğu (%22.6), duygudurum bozuklukları (%12.9), iletişim bozuklukları (%9.7) ve anksiyete bozuklukları (%6.5) en sık ilk beş komorbid bozukluk olarak belirlenmiştir. Komorbid bozuklukların sıklığı açısından kız ve erkek olgular arasına istatistiksel anlamlı fark bulunmamıştır. yaş gruplarına göre komorbid atanılar incelendiğinde gerek kız kız gerekse erkeklerde duygudurum bozukluğu sıklığının yaşla birlikte anlamlı derecede arttığı görülmüştür (p<0.05). Diğer komorbid tanıların dağılımı yaş grupları arasında anlamlı fark göstermemiştir. Tartışma: Çalışmanın sonuçları DEHB'nda komorbiditenin varlığını ve önemini desteklemektedir. karşı gelme bozukluğu ve davranım bozukluğu, bu alandaki literatürle uyumlu olarak en sık belirlenen komorbid bozukluklardır. Ergenlik döneminde davranım bozukluğu ve karşı gelme bozukluğunun yanısıra duygudurm bozuklukları tabloya eklenmekte ve klinik görünüm ve tedaviye yanıt önemli ölçüde etkilenmektedir.

A Study of Adolescents' Self-Esteem and Their Perceptions about Parental Attitudes
Objective: Comorbid psychiatric disorders and effects of age and gender on comorbidity in children and adolescents, diagnosed with attention deficit hyperactivity disorder, are studied. Method: This study covers 137 patients who are referred by their pediatricians and family physcians to ADHD Clinic Training nad Research Institute of the Scarborough General Hospital in Canada for evaluation of ADHD and subsequently diagnosed as ADHD according to DSM-IV criteria. Frequency of comorbid psychiatric disorders in ADHD subjects and distribution of these diagnosis according to age to gender were studied. Results: 29.9% of the subjects did not have any comoborbid psychiatric disorder. 35% of the subjects ad one comorbid disorder, 25.5 of the subjects had two comorbid disorders, and 8% of them had theree comoborbid disorders. The most common comorbid diganosis in male patients was oppotional defiant disorder (ODD) (62.3%), the other comorbid disorders observed were conduct disorder (22.6%), communication disorders (11.3%), mood disorders (7.5%), and anxiety disorders (6.6%). In female subjects the most common five comorbid disorders were classified as ODD (54.8%), conduct disorder (22.6%), mood disorders (12.9%), communication disorders (9.7%), and anxiety disorders (6.5%). No significant difference of prevelance of comorbid disorders was found between male and female subjects. It was observed that the prevalance of comorbid depressive disorders were significantly increased, for both male and female subjects by age (p<0.005). Prevalance of communication disorders among the male subjects was significantly decreased by age (p<0.05). No significant diffrence regarding other comorbid diagnosis was found between different age groups. Discussion: Results of the study support the presence and importance of the comorbidity in ADHD. The ODD and CD are the most common disorders as it is indicated in the literature. In adolescence, mood disorders are added to the ODD and CD resulting in alternations in the clinical view and also in response to the therapy.

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