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Defizite in den Exekutivfunktionen von Kindern mit ADHS

Zur klinischen Validität des ADHS-Diagnostikums für Kinder und Jugendliche (ADHS-KJ)

Published Online:February 27, 2019https://doi.org/10.1026/0942-5403/a000279

Abstract

Zusammenfassung. Das Erhebungsverfahren ADHS-KJ beinhaltet eine differenzierte neuropsychologische Erfassung der exekutiven Funktionen sowie eine standardisierte Verhaltensbeobachtung des hyperaktiven Verhaltens von Kindern und Jugendlichen im Alter von 6;0 bis 12;11 Jahren. Die Aussagekraft des neuropsychologischen Moduls des ADHS-KJ wurde anhand einer Gruppe von Kindern mit einer ADHS-Diagnose (n = 58) und einer parallelisierten Kontrollgruppe untersucht (n = 58); es wurde überprüft, inwieweit das Alter und die medikamentöse Behandlung der Kinder die Ergebnisse beeinflussten. Zusätzlich wurden die neuropsychologischen Ergebnisse mit Befunden einer standardisierten Verhaltensbeobachtung in Zusammenhang gesetzt. Es wurde belegt, dass das Erhebungsverfahren ADHS-KJ zwischen Kindern mit und ohne eine ADHS auf der Basis der Komponenten der exekutiven Funktionen und des darauf bezogenen Gesamttestwertes des ADHS-KJ sowie der Beobachtung des hyperkinetischen Verhaltens differenzieren konnte. Die Unterschiede zwischen der ADHS- und Kontrollgruppe wurden durch kleine (d = .36) bis große (d = .95) Effektstärken gekennzeichnet. Das Erhebungsverfahren ADHS-KJ differenzierte deutlich zwischen jüngeren und älteren Kindern mit ADHS (d  ≥ 1.00). Das Erhebungsverfahren ADHS-KJ kann als multimodales und multimethodales Vorgehen für die Diagnostik einer ADHS empfohlen werden, wobei die Auffälligkeiten in den Exekutivfunktionen besonders kennzeichnend für Kinder der Altersgruppe von sechs bis acht Jahren sind.


Deficits in Executive Functions of Children With ADHD: Clinical Validity of a Diagnostic Instrument for ADHD in Children and Adolescents (ADHS-KJ)

Abstract. The diagnosis of attention deficit hyperactivity disorder (ADHD) poses a challenge to therapists because ADHD has been declared a behavioral disorder for a long time. Therefore, the diagnosis is based on observable behavior, which is subject to various deviations. According to the current understanding of the disorder, the self-regulation of children with ADHD is disturbed, which is associated with deficits in executive functions. The aim of this study was to validate a diagnostic instrument for ADHD (ADHS-KJ; Petermann & Petermann, 2019) and to check whether the neuropsychological test and the Behavioural Observation Scale of Hyperactivity differ between children with ADHD (n = 58) and a parallel control group (n = 58). In addition, we controlled for age effects comparing the scores of children in the neuropsychological test and the Behavioral Observation Scale in two age groups (n = 14: 6.0 – 7.99 and n = 13: 10.0 – 12.99). The influence of psychopharmacological medication on these scores was also examined by comparing children with ADHD who received some medication (n = 31), children with ADHD without medication (n = 27), and children without ADHD (n = 31). Multivariate variance analyses were performed to investigate group differences using effect sizes (Cohen’s d) to evaluate the magnitude of differences in the executive functions between the clinical and the control group. The results of the present study showed significant differences between children with and without clinical ADHD in the area of Flexible Attention Control Deficits: Divided Attention (Subtest 1; d = .40), Deficits in Action Planning to Achieve a Goal Without Errors (Subtest 2; d = .57), Deficits in Inhibition of External Stimuli for Attention Control (Subtest 3; d = .36), Deficits in Inhibition of Internal Impulses to the Reaction Stop (Subtest 4; d = .39), overall Deficits of the Executive Functions (DEF; d = .63), and the Behavioural Observation Scale of Hyperactivity (VBH; d = .95). These effect sizes are to be interpreted as small to large. Age differences were detected in all subtests, with the exception of the subtest Deficits in Inhibition of Internal Impulses for Reaction Stop. Differences were also found in the overall score of Deficits of the Executive Functions (DEF) and the Behavioral Observation Scale of Hyperactivity (VBH) with large effect sizes (d ≥ 1.00). Influences related to medications of children with an ADHD diagnosis were only found to be significant in the subtest Deficits in Inhibition of External Stimuli for Attention Control (d =.70). The study was able to detect significant differences of the ADHD group in comparison with the control group as well as difference in the age group comparison. These findings support the hypothesis that the diagnostic instrument ADHS-KJ is suitable for use in diagnostics of children without medication. The multimodal and multimethod diagnostic instrument ADHS-KJ is recommended in the diagnostics of ADHD in order to support the observable behavior of the affected child with psychometrically secured data and to identify the exact source of possible impairments or deviations. The information provided by the ADHS-KJ makes a significant contribution to diagnostic clarification and individual therapy planning.

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