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Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS): Wie valide sind die Subtypen?

Published Online:September 01, 2006https://doi.org/10.1026/0942-5403.14.4.244

Abstract

Zusammenfassung. Bereits mit Erscheinen des DSM-IV wurde die Validität der dort benannten Subtypen der ADHS hinterfragt. Hinzu kommt eine abweichende Subgruppenbildung in der ICD-10. Seitdem sind die Subtypen in verschiedenen Zusammenhängen untersucht worden. Dabei festgestellte Unterschiede und Gemeinsamkeiten der Subtypen werden aus sechs Perspektiven (verhaltensbezogen, genetisch, geschlechtsspezifisch, entwicklungsbezogen, neurobiologisch, neuropsychologisch) betrachtet, um Informationen über mögliche notwendige Veränderungen im DSM-V zu erlangen. Die Befunde legen zunächst nahe, sich bei zukünftigen Klassifikationskriterien nicht auf die Verhaltensebene zu beschränken, sondern insbesondere neuropsychologische aber auch neurobiologische Aspekte einzubeziehen. So wird unter Berücksichtigung dieser Ebenen für den bisherigen vorwiegend unaufmerksamen Subtyp eine weitere Differenzierung angedeutet: in eine Gruppe mit verlangsamtem kognitiven Tempo, die eventuell sogar eine eigenständige Störung darstellt, sowie einen vorwiegend unaufmerksamen Subtyp der ADHS, der aber schwache Symptome der Hyperaktivität und Impulsivität aufweist. Des Weiteren deutet sich zwar auf einigen Ebenen ein eigenständiger Subtyp ADHS mit komorbiden Störungen des Sozialverhaltens beziehungsweise einer Hyperkinetischen Störung des Sozialverhaltens an. Jedoch sind Befunde anderer Ebenen noch nicht eindeutig und somit ist weitere Forschung notwendig. Zudem scheinen gesonderte Kriterien für die Geschlechter nicht erforderlich, vielmehr sollte stärker beachtet werden, dass auch Mädchen diese Störung aufweisen können. Abschließend werden Implikationen für zukünftige Klassifikationen und ihre Bedeutung für unterschiedliche Behandlungsverfahren diskutiert.


Attention-Deficit/Hyperactivity Disorder (ADHD): Validity of the subtypes

Abstract. Already with the publication of the DSM-IV the validity of the DSM-IV subtypes of ADHD was questioned. In addition, the ICD-10 describes different guidelines for subtype classification. Ever since the subtypes have been examined in many different ways. To gain further information about necessary alterations of the DSM-V, the differences and points in common found in the subtypes are presented. Six different approaches are considered (behavioral, genetic, gender, developmental, neurobiological, and neuropsychological). The results suggest considering additional aspects beyond behavioral symptom criteria - especially neurobiological and neuropsychological criteria. Thereby a differentiation of the predominantly inattentive subtype is supported: into a) a subgroup with sluggish cognitive tempo, which possibly represents an independent disorder and b) a predominantly inattentive subtype of ADHD, but with slight symptoms of hyperactivity and impulsivity. Furthermore, some approaches imply an independent ADHD aggressive subtype or hyperkinetic conduct disorder. But up to the present the results are not univocal so that additional studies are required. It seems unnecessary to develop special criteria for boys and girls; but it must be taken into consideration more carefully that girls can also have ADHS. Finally, implications for future classification systems of ADHD and their relevance to different treatment approaches are discussed.

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