Publikationsserver der Universitätsbibliothek Marburg

Titel: Familiärer Stress und Symptome der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Vorschulkindern
Autor: Schloß, Susan
Weitere Beteiligte: Becker, Katja (Prof. Dr.)
Veröffentlicht: 2017
URI: https://archiv.ub.uni-marburg.de/diss/z2017/0458
DOI: https://doi.org/10.17192/z2017.0458
URN: urn:nbn:de:hebis:04-z2017-04580
DDC: 610 Medizin, Gesundheit
Titel(trans.): Family stress factors and symptoms of attention deficit/hyperactivity disorder in preschoolers
Publikationsdatum: 2017-09-07
Lizenz: https://creativecommons.org/licenses/by-nc-sa/4.0

Dokument

Schlagwörter:
maternal depressive symptoms, preschool age, interparental conflict, Cortisol, elterliche Partnerschaftskonflikte, self-regulation, ADHS, Selbstregulation, HPA axis, ADHD, cortisol, Mütterliche Depressivität, effortful control, Vorschulalter, stress, Stress

Zusammenfassung:
Hintergrund: Bei der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) handelt es sich um eine entwicklungsneurologische Störung. Exekutive Inhibitionskontrolle und Belohnungsaufschub sind ADHS-bezogene neuropsycholo- gische Basisdefizite, die kausale Entwicklungspfade („causal pathways“) der ADHS kennzeichnen könnten. Darüber hinaus weist die aktuelle Theorien- bildung auf Vulnerabilitäts- bzw. transaktionale Prozesse hin, die an einigen Entwicklungspfaden der ADHS beteiligt sein könnten. Demzufolge könnten Schwierigkeiten im Bereich der Inhibitionskontrolle und des Belohnungsaufschubs die Wahrscheinlichkeit eines Kindes erhöhen, unter psychosozialen Ri- sikobedingungen ADHS-Symptome zu entwickeln. Psychosozialer Stress wurde als einer der Auslöser und Einflussfaktoren auf den Verlauf der ADHS konzeptionalisiert. Die Haarcortisolkonzentration wird als Biomarker für chronischen Stress über mehrere Monate erachtet. Bisher existiert keine Studie, die ADHS- Symptome, Basisdefizite und die Haarcortisolkonzentration untersucht hat. Das Ziel der vorliegenden Dissertation besteht darin zu analysieren, ob Inhibitionskontrolle und Belohnungsaufschub den Zusammenhang zwischen psychosozialen Risiken (bzw. der Cortisolkonzentration) und ADHS-Symptomen bei Vorschulkindern moderieren. Methode: Die Stichprobe besteht aus n=206 Familien mit Kindern im Alter von vier und fünf Jahren. Von n=126 Kindern liegen Haarproben vor. Die Stichprobe wurde um Kinder, die die 70. Perzentile eines ADHS-Screeningfragebogens (FBB-ADHS-V) überschritten, und um Kinder, deren Geschwisterkind von ADHS betroffen ist oder war, angereichert. Die ADHS-Symptome wurden durch ein strukturiertes klinisches Interview mit einem Elternteil und Fragebögen für Eltern und Erzieher erhoben. Mütterliche Depressivität wurde mit Hilfe eines Selbstbeurteilungsfragebogens erhoben. Die Qualität der elterlichen Partnerschaft wurde durch Fragebögen für Mütter und Väter ermittelt. Inhibitionskontrolle und Belohnungsaufschub wurden durch neuropsychologische Tests erhoben. Zur Ermittlung der Langzeitcortisolausschüttung wurden 3cm des Kopfhaars des Kindes analysiert. Komorbide oppositionelle, Angst- und depressive Symptome wurden durch Fragebögen erhoben. Die Intelligenz wurde durch zwei Subtests eines Intelligenztests geschätzt. Zur Ermittlung mütterlicher ADHS-Symptome kamen ein Fragebogen und ein strukturiertes klinisches Interview zum Einsatz. Ergebnisse: Nach statistischer Kontrolle mütterlicher ADHS-Symptome und Schulbildung sowie der kindlichen Intelligenz, oppositionellen, Angst- und de- pressiven Symptome und des Geschlechts ergaben sich keine signifikanten In- teraktionseffekte, wenn Inhibitionskontrolle als Moderatorvariable verwendet wurde. Der Interaktionseffekt zwischen Belohnungsaufschub und mütterlicher Depressivität, Partnerschaftskonflikten und Haarcortisolkonzentration war jeweils statistisch signifikant. Bei Kindern mit Schwierigkeiten beim Belohnungsaufschub waren hohe ADHS-Symptome mit hohen mütterlichen depressiven Symptomen, einer geringen Partnerschaftsqualität der Eltern und hoher Cortisolkonzentration im Haar verbunden. Bei Kindern ohne diese Schwierigkeiten war die Assoziation nicht signifikant. Schlussfolgerungen: Die Ergebnisse stimmen mit der Annahme überein, dass das neuropsychologische Basisdefizit Belohnungsaufschub das Kind anfälliger dafür machen könnte, unter psychosozialen Risikobedingungen ADHS- Symptome zu entwickeln. Belohnungsaufschub könnte als sich früh entwickelnder Vulnerabilitätsmarker in Frage kommen, der einen der kausalen Entwick- lungspfade zur ADHS, an denen transaktionale Prozesse mit Umweltfaktoren beteiligt sind, kennzeichnet. Die Konstellation ’Schwierigkeiten beim Be- lohnungsaufschub/hohe Haarcortisolkonzentration’ könnte einen spezifischen ADHS-Subtyp kennzeichnen. Dies bedarf jedoch weiterer Forschung.

Summary:
Background: Attention deficit/hyperactivity disorder (ADHD) is regarded as a neurodevelopmental disorder. Executive inhibitory control and delay of gratification constitute ADHD-related neuropsychological basic deficits, that may indicate “causal pathways” to ADHD. Moreover, current theorizing points to vulnerability/transaction processes that might be involved in some of the causal pathways leading to ADHD. Thus, deficits in inhibitory control and delay of gratification might increase the probability of developing ADHD symptoms under psychosocial risk conditions. Among the ADHD-related psychosocial risk factors, maternal depression and interparental conflict have been shown to be the most closely associated with ADHD. Psychosocial stress has been conceptualized as a trigger for ADHD and as a factor that influences the course of the disorder. Hair cortisol concentration is considered as a biomarker of prolonged stress (several months). To date, there are no studies on ADHD symptoms, basic deficits, and hair cortisol concentration. The aim of this dissertation is to analyze whether inhibitory control and delay of gratification act as moderator variables of the association between these psychosocial risks (and hair cortisol concentration respectively) and ADHD symptoms in preschool children. Methods: The sample consisted of n=206 families with four- to five-year- old children. Hair samples were taken from n=126 children. The sample was enriched with preschoolers who exceeded the 70th percentile of an ADHD screening questionnaire (FBB-ADHS-V) and children whose sibling is or was 139 affected by ADHD. ADHD symptoms were assessed by a clinical interview with parents and questionnaires filled in by parents and nursery teachers. Maternal depressive symptoms were assessed by a self-rating questionnaire; interparental conflict was assessed by a questionnaire filled in by mothers and fathers. For determination of long-term cortisol exposure, 3cm of scalp hair were used. Inhibitory control and delay of gratification were determined by a set of neu- ropsychological tasks. Intelligence level was estimated by two subtests of an intelligence test. Comorbid oppositional, anxious, and depressive symptoms were assessed by questionnaires. Maternal ADHD symptoms were assessed by a questionnaire and a structured clinical interview. Results: After controlling for maternal ADHD symptoms and education level, and for gender, intelligence, anxiety/depressive and oppositional symptoms of the child, none of the interaction effects using inhibitory control as a moderator variable proved to be statistically significant. The interaction effects between delay of gratification and maternal depressive symptoms, interparental conflict as well as hair cortisol concentration were statistically significant. For children with delay of gratification deficits, high ADHD symptoms were associated with high maternal depressive symptoms, high interparental conflict and high hair cortisol concentrations. For children without these deficits, the association was not significant. Conclusions: The findings are in line with the assumption that the neuropsychological basic deficit delay of gratification predisposes the child to develop ADHD symptoms under psychosocial high-risk conditions. Delay of gratification might be regarded as an early-developing vulnerability marker, indicating one causal pathway that involves transaction processes with environmental risk factors. The constellation ’low delay of gratification/high hair cortisol concentration’ might reflect a specific ADHD subtype, which requires further investigation.

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