Begleitsymptomatik bei tief greifenden Entwicklungsstörungen
I. Intelligenzminderung und psychiatrische Komorbidität
Abstract
Fragestellung: Neuere Untersuchungen belegen eine höhere Prävalenz für autistische Störungen als die ersten epidemiologischen Untersuchungen erwarten ließen. In dieser Untersuchung wird überprüft, wie häufig eine Intelligenzminderung sowie komorbide psychiatrische Störungen in einer klinischen Stichprobe von Patienten mit tief greifenden Entwicklungsstörungen anzutreffen sind. Methodik: Die Stichprobe besteht aus 601 Patienten mit einer tief greifenden Entwicklungsstörung. Für alle Patienten wurde das Intelligenzniveau bestimmt. Auf Achse I wurden bis zu zwei weitere Diagnosen kodiert sowie behandlungsrelevante Symptome erfasst (Ess- und Schlafstörungen, autoaggressives Verhalten), auf den Achsen V und VI die psychosozialen Belastungsfaktoren und das Gesamtniveau der psychosozialen Anpassung. Ergebnisse: Bei 26 % der Patienten lag das Intelligenzniveau im Normbereich (N = 158). 54 % aller Patienten (N = 325) hatten eine, 19 % (N = 110) zwei weitere psychiatrische Diagnosen. Die häufigsten Diagnosen waren externalisierende Störungen (N = 221). Internalisierende (N = 96) und sonstige Störungen (N = 114) kamen nur halb so oft vor. Autoaggressives Verhalten lag vor allem bei schweren Intelligenzminderungen vor. Es gab einen signifikanten Zusammenhang zwischen dem Auftreten von (auto-)aggressivem Verhalten und dem Ausmaß der psychosozialen Anpassung. Schlussfolgerungen: Patienten mit tief greifenden Entwicklungsstörungen zeigen eine Vielzahl komorbider Symptome. Das Vorliegen externalisierender Störungen beeinträchtigt die psychosoziale Anpassung.
Objective: Recent epidemiological surveys show a higher prevalence of autism spectrum disorders than was to be expected based on the first studies in this field. The objective of our study is to analyse the frequency of mental retardation and co-morbid psychiatric disorders and symptoms in a large clinical sample of patients with pervasive developmental disorders. Method: The sample consists of all patients (N = 601) with a pervasive developmental disorder diagnosed at the Department of Developmental Disorders at the Heckscher-Klinikum. For all patients the level of intellectual functioning was measured. In addition to psychiatric diagnoses, we also recorded intervention-relevant symptoms such as eating and sleeping problems, and auto-aggressive behavior on Axis I, as well as psychosocial impairments and level of psychosocial functioning on Axes V and VI. Results: 26% of the patients functioned on a normal intellectual level (N = 58). 54% of the patients (N = 325) had at least one additional psychiatric diagnosis, and 19% (N = 110) had two additional diagnoses. The most frequent diagnoses were externalizing disorders (N = 221). Internalizing disorders (N = 96), as well as other disorders (N = 114) were about equally frequent. Auto-aggressive behavior occurred more often among children with severe mental retardation than in children of normal intelligence. There was a significant association between the presence of (auto-)aggressive behavior as well as externalizing diagnoses and the level of psychosocial functioning. Conclusions: Children with pervasive developmental disorders show a wide variety of co-morbid problems, which are relevant for the treatment and the course of the disorder. The presence of externalizing behaviors is an additional burden on the development of these children.
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