Diagnostische Merkmale und Therapieergebnis bei stationär behandelten hyperkinetischen Kindern und Jugendlichen

Abstract. Objective: In the context of growing expenses in medicine the quality control of therapies becomes more and more important. In this thesis a clinically treated inpatient group of children with diagnosed ADHD (attention deficit hyperkinetic disorder) using ICD-10 criteria (F90, n=104) is observed as part of a bigger empirical quality-evaluation project taking place at the Clinic of Children and Youth Psychiatry of Philipps University Marburg. As it is the first time that an inpatient group diagnosed ADHD (F90) is examined in such a detailed manner, this thesis is mainly held in a descriptive-explorative way. Specific hypothesis are statistically tested. The hyperkinetic subgroup in question in this thesis is part of all the patients that were treated in Marburg`s Clinic of Children and Youth Psychiatry during the 9 year period of 1st January 1992 to 31st December 2000. It is compared to other clinically treated groups of the same period: on the one hand to all other clinically treated children in this timerange, on the other hand within the group of external behaviour disorders, which comprises children suffering from social disorders as oppositional deficit disorder (ODD) or conduct disorder (CD) – diagnosed using ICD-10 criteria (F91/F92) – and ADHD (F90). Furthermore some subgroups of children diagnosed ADHD (F90) are compared amongst each other. Method: Used data is taken from the clinic`s basis-documentation as well as from other questionnaires developed and tested during the clinic`s big quality-evaluation project. There are 4 evaluation periods: beginning and end of treatment, 4-6 weeks after and 1-1,5 years after the end of treatment. Besides data from the basis-documentation, telephone interviews and a questionnaire called LISTE (list of individual symptoms for therapy evaluation) were used to get individual information about the level of therapy success. Data was taken concerning sociodemographic/environmental factors, comorbidity, intelligence/functionality, therapy/cooperation and the success of therapy. All data from the 9 year period was filtered using 5 reduction levels. The first level reduced 2910 so called “episodes” (stays in Marburg`s Clinic of Children and Youth Psychiatry) to “one episode per patient”. The other reduction levels were used for detailed arrangements of all present data. To be able to combine ADHD (F90) children with patients suffering from social behaviour disorders (F91/F92) three groups of n=91 male children were built by matching process. Concerning the three ADHD subgroup comparisons ADHD children 1) with and without comorbid F91/F92, 2) with and without comorbid learning disorders and 3) with and without stimulant medication were examined. Results: The group of F90 children at Marburg`s Clinic of Children and Youth Psychiatry represents a typical group of children showing attention deficit hyperkinetic disorder as described in literature. Additionally I found a high comorbidity of F90 children with enuresis and disorders in social functioning beginning in childhood and youth. The short term therapy success for F90 children is equal to all other diagnosis-groups treated at Marburg`s Clinic of Children and Youth Psychiatry (85% of ameliorated children). The long term therapy success is not as good – as described in literature. In comparison to the other external behaviour disorders (F91/F92) hyperkinetic children with comorbid social disorders (F90.1) showed statistically a better success of therapy in short term (83% patients ameliorated in comparison to 77,4%) – contrasting our initial hypothesis based on literature; in long term there were no significant differences (76% patients ameliorated in all groups) – surprisingly the F91 subgroup showed a better result 1-1,5 years after treatment than at the end of treatment. Quite unexpected, subgroups of hyperkinetic children regardless to their comorbidity demonstrated surprisingly good results (83% patients ameliorated at the end of treatment) and were stable concerning the success of therapy. A comparison of subgroups was only possible for F90 children treated with or without stimulant medication because of too small a number of cases relating the other subgroups. F90 children treated with stimulant medication had statistically a better outcome in short and long term than children without stimulant treatment. Conclusion: The F90 diagnosed inpatient group treated at Marburg`s Clinic of Children and Youth Psychiatry represents a typical ADHD (F90) diagnosed group of children as described in literature. It achieves very good and stable therapeutic results – independent of comorbid disorders – and succeeds well in long term (76% patients ameliorated).