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Free AccessThemenschwerpunkt

Zur Bedeutung auffälliger Exekutivfunktionen in der Diagnostik einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung

Published Online:September 24, 2018https://doi.org/10.1024/1661-4747/a000359

Abstract

Zusammenfassung. Defizite in Exekutivfunktionen und insbesondere in der Inhibitionsfähigkeit gelten verschiedenen Modellen zufolge als Kerndefizite einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS). Die Defizite sind sowohl auf einer Verhaltensebene als auch auf neurobiologischer Ebene belegt, finden aber bislang kaum Einzug in die klinische Diagnostik. Verschiedene Erhebungsverfahren werden vorgestellt und die Probleme im Bereich der klinischen Diagnostik skizziert. Viele Aufgaben messen nicht eine spezifische Exekutivfunktion, sondern umfassen immer auch andere kognitive Prozesse wie zum Beispiel Aufmerksamkeit oder Test- und Leistungsmotivation. Die Sensitivität vieler Aufgaben ist aufgrund der Heterogenität von ADHS durch verschiedene Entwicklungspfade oft nicht gewährleistet und Defizite in Exekutivfunktionen und der Inhibitionsfähigkeit sind auch nicht spezifisch für ADHS. Dennoch ist eine Diagnostik auffälliger Exekutivfunktionen und insbesondere von Defiziten in der Inhibitionsfähigkeit angebracht, da nur so Aussagen über zugrunde liegende Prozesse und Ursachen einer ADHS getroffen werden können, welche die Voraussetzung für gezielte Interventionen darstellen, wie zum Beispiel Inhibitionstrainings oder Neurofeedback.


On the Relevance of Impaired Executive Functions in the Diagnostics of Attention-Deficit/Hyperactivity

Abstract. Deficits in executive functions, in particular in behavioral inhibition, are at the core of several theoretical models of Attention Deficit Hyperactivity Disorder (ADHD). These deficits have been demonstrated on a behavioral and on a neurobiological level. However, clinical diagnostics of ADHD only rarely contain instruments to assess executive functions or behavioral inhibition. Several instruments to measure executive functions are presented and difficulties in their use are discussed. Many tasks suffer from the task impurity problem: They do not measure one specific executive function. Instead, several other cognitive (e.g., attention) and motivational processes (e.g., test motivation or achievement motivation) are involved. Due to the heterogeneity of ADHD and different developmental pathways of the disorder, measures of executive functions lack sensitivity. In similar, the specificity is compromised as well as deficits in behavioral inhibition and executive functions are not limited to ADHD. However, the clinical diagnostics of executive functions and, in particular, behavioral inhibition are recommended in order to enable assertions on impaired underlying mechanisms and processes. Such assertions are necessary to apply specific interventions, as for instance, trainings of behavioral inhibition or neurofeedback.

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