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ADHS bei Erwachsenen

Ein dimensionales oder kategoriales Konstrukt?

Published Online:https://doi.org/10.1024/1661-4747/a000311

Zusammenfassung. Klassifizierungs- und Strukturierungsmöglichkeiten psychischer Störungen und Konstrukte sind in den letzten Jahren zu einem Schwerpunkt empirischer Forschung geworden. Im Mittelpunkt steht dabei die Debatte um die bisherige kategoriale versus einer neuen dimensionalen Sichtweise. ADHS gehört zu den Störungsbildern, für welche ein dimensionales Konzept plausibel erscheint. Empirische Belege hierfür liefern verschiedene taxonomische Studien an Kindern und Jugendlichen mit ADHS. Für Erwachsene gibt es bisher nur wenig empirische Untersuchungen zu dem Thema. Daher ist die vorliegende Studie eine erste Auseinandersetzung mit der Beschaffenheit von ADHS bei Erwachsenen, wobei den Befunden bei Kindern folgend von einer dimensionalen Struktur ausgegangen wird. Zwei Stichproben wurden zur Beantwortung der Fragestellung herangezogen: 605 Personen einer gesunden Normalstichprobe und 722 Personen aus einer klinischen Stichprobe, bestehend aus 336 Personen ohne ADHS-Diagnose und 386 Personen mit ADHS-Diagnose. Untersucht wurden alle Personen mittels der ADHS-Selbstbeurteilungsskala (ADHS-SB). Zur statistischen Überprüfung der Fragestellung wurden Diskriminanzanalysen und eine Faktorenanalyse durchgeführt, weiterhin wurden finite Mischverteilungsmodelle mit Hilfe des EM-Algorithmus gerechnet. Die Diskriminanzanalysen konnten zeigen, dass Grenzwerte nur bedingt dazu in der Lage sind, zwischen Personen mit und ohne ADHS zu diskriminieren. Die Faktorenanalyse ergab für alle Gruppen die gleiche Zwei-Faktoren-Lösung der ADHS, welche auch vom DSM-5 vorgeschlagen wird (Unaufmerksamkeit, Hyperaktivität/Impulsivität). Weiterhin wiesen die Mischmodelle der verschiedenen Gruppen keine Unterschiede auf, welche eine kategoriale Sichtweise rechtfertigen würden. Insgesamt ist eine dimensionale Struktur des Störungsbildes auch bei Erwachsenen als wahrscheinlich anzunehmen. Dies bedeutet, dass die Symptome der ADHS extreme Ausprägungen normaler psychischer Phänomene darstellen und es keine klaren Grenzen zwischen Personen mit und ohne einer adulten ADHS gibt. Trotz möglicher dimensionaler Struktur handelt es sich bei der ADHS um eine psychische Störung. Das Abklären funktioneller Beeinträchtigungen könnte vermehrt helfen, Behandlungswürdigkeit festzustellen.


ADHD in adults: A dimensional or categorial construct?

Abstract. In recent years, attention in empirical research has been drawn to the classification and structuring of mental disorders and constructs. Particular attention has been paid to the debate between the current categorical vs. a new dimensional approach. As a childhood mental disorder, ADHD seems to be a clinical picture fitting a dimensional concept. Various taxonomic studies supply empirical evidence for this in children and adolescents with ADHD. However, for adults, there has been little empirical research so far. Thus, this present study is a first exploration of the nature of ADHD in adults. Based on the findings of ADHD in childhood, we hypothesize a dimensional structure for adults as well. Two samples were used to test our hypothesis: 605 people of a healthy normal sample and 722 individuals from a clinical sample consisting of 336 individuals without an ADHD diagnosis and 386 individuals with an ADHD diagnosis. All analyzes were based on the ADHD Self-Report Scale (ADHD-SR). Primarily discriminant and factor analysis were conducted, subsequently finite mixture models were calculated using the EM algorithm. The discriminant analysis revealed that cut-off values only discriminated partially between individuals with and without ADHD. The factor analysis for all groups resulted in the same two-factor solution of ADHD, which is also proposed by the DSM-5 (inattention, hyperactivity/impulsivity). The mixed models of the different groups could not been distinguished. These findings lead to the conclusion that a dimensional structure of the disorder can be considered to be very likely. In other words, the symptoms of ADHD represent extreme forms of normal human behavior and there are no clear boundaries between people with and without an adult ADHD. Albeit its possible dimensional structure, ADHD is a mental disorder. Recording severe functional impairments could help determine whether psychotherapeutic or psychiatric treatment is required.

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