Abstract
Amaç
Dikkat Eksikliği Hiperaktivite Bozukluğu‟nda (DEHB) önemli fonksiyonel kayıplara
neden olan öfke, irritabilite ve engellenme toleranssızlığı gibi duygu düzenleme güçlükleri
(DDG) görülebilir. Bu araştırmada DEHB tanılı çocuk ve ergenler ile sağlıklı kontrol
grubunu duygu düzenleme özellikleri bakımından karşılaştırmak, duygu düzenleme güçlüğü
ile ilişkili olabilecek faktörleri incelemek amaçlanmıştır.
Gereç ve Yöntem
Araştırma Namık Kemal Üniversitesi Tıp Fakültesi, Çocuk ve Ergen
Psikiyatri polikliniğinde DSM-V tanı kriterlerine göre DEHB tanısı konulan 6-18 yaş
aralığında 72 çocuk-ergen ve 30 sağlıklı kontrol ile yürütülmüştür. Okul Çağı Çocukları için
Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi – Şimdi ve Yaşam Boyu Şekli
(ÇDŞG – ŞY) yarı yapılandırılmış görüşme formu kullanılarak komorbiditeler belirlenmiştir.
Çocukluk Çağı Davranış Değerlendirme Ölçeği (ÇDDÖ) ile duygu düzenleme güçlüğü
(DDG=dikkat+anksiyete/depresyon+agresyon alt ölçekleri) puanı elde edilmiştir.
Bulgular
DEHB grubunda DDG puanı 1--89.45±19.33 iken, sağlıklı kontrol grubunda
DDG puanı 164.13±9.94 olarak bulunmuştur. İki grup arasında DDG puanları bakımından
anlamlı fark saptanmıştır (p˂0.001**). DEHB grubu klinik özellikler bakımından
değerlendirildiğinde eş psikiyatrik bozuklukların DDG ile ilişkili olmadığı, DEHB bileşik
görünüm özelliklerinin ise DDG için önemli yordayıcı olduğu sonucu elde edilmiştir
(p=0.011*).
Sonuç
Bu araştırmanın sonuçları DEHB tanılı bireylerde DDG‟nün sağlıklı kontrollere göre
anlamlı düzeyde fazla olduğu ve DEHB bileşik görünümün DDG için yordayıcı olduğu
sonucunu ortaya koymuştur. DEHB‟ye eşlik eden duygu düzenleme güçlüğü, kişide daha
fazla işlevsellik kaybına yol açtığı ve bozukluğun yetişkin yaşta devamı ile
ilişkilendirildiğinden, DEHB tanı ve tedavi sürecinde ayrıca ele alınması gereken önemli
klinik özelliklerdendir.
Keywords
References
- 1. Thompson RA. Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev 1994; 59(2-3):25-52.2. Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 2014; 171(3):276-293. 3. Stringaris A, Goodman R. Mood lability and psychopathology in youth. Psychol Med 2009; 39(8):1237-1245. 4. Copeland WE, Brotman MA, Costello EJ. Normative Irritability in Youth: Developmental Findings From the Great Smoky Mountains Study. J Am Acad Child Adolesc Psychiatry 2015; 54(8):635-642. 5. Mick E, Biederman J, Pandina G, Faraone SV. A preliminary meta-analysis of the child behavior checklist in pediatric bipolar disorder. Biol Psychiatry 2003; 53:1021-1027.6. Diler R, Uğuz S, Seydaoğlu G, Avcı A. Mania profile in community sample of prepubertal children in Turkey. Bipolar Disord 2008; 10:546-553.7. Kutlu A, Akyol Ardic U, Ercan ES. Effect of Methylphenidate on Emotional Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder + Oppositional Defiant Disorder/Conduct Disorder. J Clin Psychopharmacol 2017; 37(2):220-225. 8. Kaufman J, Birmaher B, Brent D. Schedule for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36(7):980-988.9. Gökler B, Ünal F, Pehlivantürk B, et al. Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşamboyu Şekli-Türkçe Uyarlamasının Geçerliliği ve Güvenilirliği. Çocuk ve Gençlik Ruh Sağlığı Dergisi 2004; 11(3):109-116.10. Achenbach TM. Manual for the Child Behavior Checklist/4-18 and 1991 profile. University of Vermont, Department of Psychiatry, Burlington VT, 1991.11. Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1:15020. 12. Anastopoulos AD, Smith TF, Garrett ME, Morrissey-Kane E, Schatz NK, Sommer JL, et al. Self-Regulation of Emotion, Functional Impairment, and Comorbidity Among ChildrenWith AD/HD. J Atten Disord 2011; 15(7):583-592. 13. Lee CA, Milich R, Lorch EP, Flory K, Owens JS, Lamont AE, et al. Forming first impressions of children: the role of attention-deficit/hyperactivity disorder symptoms and emotion dysregulation. J Child Psychol Psychiatry 2018; 59(5):556-564. 14. Bunford N, Evans SW, Langberg JM. Emotion Dysregulation Is Associated With Social Impairment Among Young Adolescents With ADHD. J Atten Disord 2018; 22(1):66-82. 15. Banaschewski T, Jennen-Steinmetz C, Brandeis D, Buitelaar JK, Kuntsi J, Poustka L, Sergeant JA, et al. Neuropsychological correlates of emotional lability in children with ADHD. J Child Psychol Psychiatry 2012; 53(11):1139-1148.16. Özyurt G, Pekcanlar AA, Öztürk Y, Baykara B, Emiroğlu Nİ. Dikkat eksikliği ve hiperaktivite bozukluğu olan çocuklarda ve annelerinde duygu düzenlemenin araştırılması. Anadolu Psikiyatri Derg 2016; 17:393-402.17. Barkley RA. Emotional dysregulation is a core component of ADHD. In RA. Barkley (Ed.), Attention-deficit hyperaktivity disorder. A handbook for diagnosis and treatment (4th edn) New York: Guilford Press, 2015.18. Sobanski E, Banaschewski T, Asherson P, Buitelaar J, Chen W, Franke B, et al. Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence. J Child Psychol Psychiatry 2010; 51(8):915-923. 19. Vidal R, Valero S, Nogueira M, Palomar G, Corrales M, Richarte V, et al. Emotional lability: the discriminative value in the diagnosis of attention deficit/hyperactivity disorder in adults. Compr Psychiatry 2014; 55(7):1712-1719. 20. Faraone SV, Rostain AL, Blader J, Busch B, Childress AC, Connor DF, et al. Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder - implications for clinical recognition and intervention. J Child Psychol Psychiatry 2019; 60(2):133-150.21. Nigg JT, Casey BJ. An integrative theory of attention-deficit/ hyperactivity disorder based on the cognitive and affective neurosciences. Dev Psychopathol 2005; 17(3):785-806.22. Liu L, Chen W, Vitoratou S, Sun L, Yu X, Hagger-Johnson G, et al. Is Emotional Lability Distinct From "Angry/Irritable Mood," "Negative Affect," or Other Subdimensions of Oppositional Defiant Disorder in Children With ADHD? J Atten Disord 2016. https://doi.org/10.1177/1087054715624228.
An Examination of Emotion Regulation and Associated Factors in Attention Deficit-Hyperactivity Disorder
Abstract
Aim
Emotion regulation difficulties
(ERD) such as anger, irritability and frustration intolerance leading to severe
functional losses may be observed in attention deficit-hyperactivity disorder
(ADHD). The purpose of this study was to compare children and adults diagnosed
with ADHD and a healthy control group in terms of emotion regulation
characteristics and to examine factors potentially associated with ERD.
Method
The study was performed with 72
children/adults aged 6-18 diagnosed with ADHD based on DSM-V diagnostic
criteria at the XXXXXX Child and Adolescent Psychiatry Polyclinic, Turkey, and
30 healthy controls. The Schedule for Affective Disorders and Schizophrenia for
School-Age Children – Present and Lifetime Version (K-SADS-PL), a
semi-structured interview form, was used to determine comorbidities. ERD scores
(ERD=attention+anxiety/depression+aggression subscales) were determined using
the Childhood Behavior Checklist (CBCL).
Results
Mean ERD scores were 189.45±19.33
in the ADHD group and 164.13±9.94 in the healthy control group. A significant
difference was determined in ERD scores between the two groups (p˂0.001**).
When the ADHD group was evaluated in terms of clinical characteristics,
comorbid psychiatric disorders were not associated with ERD, but combined type
ADHD characteristics emerged as significant predictors for ERD (r=0.43,
r2=0.18, p=0.001**).
Conclusion
The results of this research revealed
significantly greater ERD in individuals diagnosed with ADHD compared to
healthy controls, and that combined type ADHD is a predictor for ERD. Since ERD
accompanying ADHD lead to greater function loss in the individual and are
associated with persistence of the disorder in adulthood, these are important
clinical characteristics also requiring evaluation during the diagnosis and
treatment of ADHD.
Keywords
References
- 1. Thompson RA. Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev 1994; 59(2-3):25-52.2. Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 2014; 171(3):276-293. 3. Stringaris A, Goodman R. Mood lability and psychopathology in youth. Psychol Med 2009; 39(8):1237-1245. 4. Copeland WE, Brotman MA, Costello EJ. Normative Irritability in Youth: Developmental Findings From the Great Smoky Mountains Study. J Am Acad Child Adolesc Psychiatry 2015; 54(8):635-642. 5. Mick E, Biederman J, Pandina G, Faraone SV. A preliminary meta-analysis of the child behavior checklist in pediatric bipolar disorder. Biol Psychiatry 2003; 53:1021-1027.6. Diler R, Uğuz S, Seydaoğlu G, Avcı A. Mania profile in community sample of prepubertal children in Turkey. Bipolar Disord 2008; 10:546-553.7. Kutlu A, Akyol Ardic U, Ercan ES. Effect of Methylphenidate on Emotional Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder + Oppositional Defiant Disorder/Conduct Disorder. J Clin Psychopharmacol 2017; 37(2):220-225. 8. Kaufman J, Birmaher B, Brent D. Schedule for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36(7):980-988.9. Gökler B, Ünal F, Pehlivantürk B, et al. Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşamboyu Şekli-Türkçe Uyarlamasının Geçerliliği ve Güvenilirliği. Çocuk ve Gençlik Ruh Sağlığı Dergisi 2004; 11(3):109-116.10. Achenbach TM. Manual for the Child Behavior Checklist/4-18 and 1991 profile. University of Vermont, Department of Psychiatry, Burlington VT, 1991.11. Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1:15020. 12. Anastopoulos AD, Smith TF, Garrett ME, Morrissey-Kane E, Schatz NK, Sommer JL, et al. Self-Regulation of Emotion, Functional Impairment, and Comorbidity Among ChildrenWith AD/HD. J Atten Disord 2011; 15(7):583-592. 13. Lee CA, Milich R, Lorch EP, Flory K, Owens JS, Lamont AE, et al. Forming first impressions of children: the role of attention-deficit/hyperactivity disorder symptoms and emotion dysregulation. J Child Psychol Psychiatry 2018; 59(5):556-564. 14. Bunford N, Evans SW, Langberg JM. Emotion Dysregulation Is Associated With Social Impairment Among Young Adolescents With ADHD. J Atten Disord 2018; 22(1):66-82. 15. Banaschewski T, Jennen-Steinmetz C, Brandeis D, Buitelaar JK, Kuntsi J, Poustka L, Sergeant JA, et al. Neuropsychological correlates of emotional lability in children with ADHD. J Child Psychol Psychiatry 2012; 53(11):1139-1148.16. Özyurt G, Pekcanlar AA, Öztürk Y, Baykara B, Emiroğlu Nİ. Dikkat eksikliği ve hiperaktivite bozukluğu olan çocuklarda ve annelerinde duygu düzenlemenin araştırılması. Anadolu Psikiyatri Derg 2016; 17:393-402.17. Barkley RA. Emotional dysregulation is a core component of ADHD. In RA. Barkley (Ed.), Attention-deficit hyperaktivity disorder. A handbook for diagnosis and treatment (4th edn) New York: Guilford Press, 2015.18. Sobanski E, Banaschewski T, Asherson P, Buitelaar J, Chen W, Franke B, et al. Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence. J Child Psychol Psychiatry 2010; 51(8):915-923. 19. Vidal R, Valero S, Nogueira M, Palomar G, Corrales M, Richarte V, et al. Emotional lability: the discriminative value in the diagnosis of attention deficit/hyperactivity disorder in adults. Compr Psychiatry 2014; 55(7):1712-1719. 20. Faraone SV, Rostain AL, Blader J, Busch B, Childress AC, Connor DF, et al. Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder - implications for clinical recognition and intervention. J Child Psychol Psychiatry 2019; 60(2):133-150.21. Nigg JT, Casey BJ. An integrative theory of attention-deficit/ hyperactivity disorder based on the cognitive and affective neurosciences. Dev Psychopathol 2005; 17(3):785-806.22. Liu L, Chen W, Vitoratou S, Sun L, Yu X, Hagger-Johnson G, et al. Is Emotional Lability Distinct From "Angry/Irritable Mood," "Negative Affect," or Other Subdimensions of Oppositional Defiant Disorder in Children With ADHD? J Atten Disord 2016. https://doi.org/10.1177/1087054715624228.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | June 28, 2019 |
| Acceptance Date | June 14, 2019 |
| Published in Issue | Year 2019 |