Komorbide Störungen bei der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung unter Berücksichtigung des Einflusses von Expressed Emotion

Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (ADHS) gehöhren zu den häufigsten psychiatrischen Erkrankungen des Kindes- und Jugendalters und gehen mit einer starken Beeinträchtigung des Patienten und seiner Familie einher. Die Kernsymptome sind Unaufmerksamkeit, Hyperaktivität und Impulsivität. K...

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Bibliographic Details
Main Author: Christiansen, Hanna
Contributors: Röhrle, Bernd (Prof. Dr. ) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2009
Online Access:PDF Full Text
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Attentiondeficit/Hyperactivity-Disorder (ADHD) is one of the most common psychiatric disorders in childhood and adolescence with severe impairment for patients and their families. Core symptoms are inattention, hyperactivity, and impulsivity. Comorbid disorders are frequent, especially externalizing disorders such as Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Genetic as well as environmental factors are crucial for phenotypic symptom characteristics that also interact with each other (G x E). Adverse family factors such as High Expressed Emotion (HEE) are highly frequent in ADHD families and seem to be relevant for the course of the disorder. This publication based cumulus introduces three different studies that focus on the etiology of ADHD, i. e. relevant genetic factors, environmental influences, and comorbid disorders as well as adverse family factors such as HEE. The first article addressed the question, whether ADHD with or without comorbid conduct problems (CP) is an etiologically and genetically distinct or a more severe disorder. Relative Risk Ratios (RRR) were calculated for siblings of cases with ADHD without and with comorbid CP. There was a higher relative risk to develop ADHD+CP for siblings of cases with ADHD+CP (Relative Risk Ratio = 4.9%) than with ADHD only. The relative risk for pure ADHD was also higher in siblings of cases with ADHD+CP as was the relative risk for CP only. Children with comorbid CP showed more severe symptoms over age-span. Our findings support family studies that assume that ADHD+CP is a distinct subtype with a high risk for cosegregation, as well as twin studies that ADHD+CP is a more severe disorder. The slightly higher relative risk for CP only shows the relevance of environmental factors. The second article assessed the relative contribution to comorbid disorders of High Expressed Emotion (HEE) as defined by high criticism/hostility and low warmth. Following an extensive parent interview assessing ADHD and comorbid internalizing and externalizing disorders, EE was coded. This measure of EE was validated with the Five Minute Speech Sample (FMSS), a well validated and widely used measure of EE. Mother’s and father’s HEE correlated highly significantly with differential influences on comorbid disorders. Mother’s HEE predicted children’s oppositional defiant disorder (ODD) and conduct disorder (CD) as well as depressive disorders. Father’s HEE predicted anxiety disorders. These differential effects of mother’s and father’s HEE should be further explored in future studies especially with respect to the development of comorbid disorders. The third article asked, whether Expressed Emotion can be manipulated experimentally and if experimentally induced psychosocial stress alters physiological responses in children with and without ADHD. Parents and their children were investigated. Children with and without ADHD and matched for age and gender were compared. EE ratings were derived from the FMSS and validated with children’s perceived criticism. Parental warmth/positive attention predicted low ratings of oppositional behaviour in ADHD children. Children also participated in a novel emotion provocation task (Hooley, Gruber, Scott, Hiller, and Yurgelun-Todd, 2005): parents were asked to either say three positive or negative things about their children in their presence. In the short computer task that followed, parents either reinforced (positive condition) or criticized (negative condition) their child’s performance. Cortisol was measured before this stress induction and in four subsequent measures. Parents of children with ADHD showed significantly higher EE than parents of control children. Psychosocial stress led to an increase in cortisol response, but only for ADHD children and only in the negative condition. The physiological reaction significantly influenced the correlation between EE and oppositional behaviour as measured with the Conners questionnaires (Conners Parent Rating Scale-Revised: Longform (CPRS-R: L); Conners Teacher Rating Scale-Revised: Longform (CTRS-R: L)).