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Die Bedeutung der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung für die Entstehung und Prognose von Störungen des Sozialverhaltens im Kindes- und Jugendalter

The role of ADHD in the etiology and outcome of antisocial behavior in children and adolescents

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Zusammenfassung

Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) und Störung des Sozialverhaltens sind zwei klar voneinander abgrenzbare neuropsychiatrische Krankheitsbilder. Die komorbide Störung ist in Kindheit und Jugend häufig und kann bei einem ungünstigen Verlauf zur Entwicklung einer Antisozialen Persönlichkeitsstörung (ASPS) führen. Im vorliegenden Artikel werden diagnostische Kriterien und epidemiologische Daten beider Störungsbilder sowie ihre wechselseitige Beeinflussung dargestellt. Dabei scheint die ADHS vor allem bei frühen Formen von Störungen des Sozialverhaltens das Risiko für einen ungünstigen Verlauf deutlich zu erhöhen. Befunde aus genetischen, psychophysiologischen und Bildgebungsstudien betonen die Bedeutung biologischer Risikofaktoren für Entstehung und Verlauf dissozialen Verhaltens. Bisher unveröffentlichte Daten einer eigenen neurokognitiven Untersuchung zu gruppenspezifischen Defiziten bei ADHS im Vergleich zur komorbiden Störung von ADHS und Störungen des Sozialverhaltens werden dargestellt. Die teils synergistische, teils interaktive Beeinflussung beider Störungen ist bislang nur unzureichend verstanden. Aktuelle Befunde deuten darauf hin, dass ein „echter Hybrid” aus beiden Störungen existiert. Vor dem Hintergrund der schlechten Prognose erscheint besonders bei der komorbiden Störung eine frühe und professionelle Behandlung der ADHS bedeutsam.

Abstract

Attention Deficit/Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) are two of the most common neurobehavioral disorders of childhood. Despite of their high comorbidity rate both disorders can be reliably differentiated. Especially the comorbid condition is associated with a poor outcome and some of the affected children develop an Antisocial Personality Disorder. This article summarizes diagnostic criteria and epidemiological data of both disorders and emphasises the role of ADHD in the aetiology and pathogenesis of antisocial behavior. ADHD seems to have a negative impact particular in children of the early-starter subtype of CD. Findings from genetic, psychophysiological and neuroimaging studies emphasise the relevance of biological risk factors in the etiological models and developmental pathways of antisocial behavior. We present so far unpublished data of children with ADHD and ADHD/disruptive behavior disorders which indicate group-specific neurocognitive impairments in the comorbid condition. ADHD and CD seem to constitute a synergistic and interactive relationship in that each disorder aggravates the other. Recent findings point to a “true hybrid” of ADHD/CD. Considering the negative outcome of the comorbid condition, several findings suggest that high-quality treatments may have considerable impact on restoring ADHD children to better functioning.

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Authors and Affiliations

  1. Universitätsklinikum Aachen, Klinik für Kinder- und Jugendpsychiatrie und –psychotherapie, Neuenhofer Weg 21, 52074, Aachen, Deutschland

    Timo D. Vloet

  2. Universitätsklinikum Aachen, Lehr- und Forschungsgebiet Klinische Neuropsychologie des Kindes- und Jugendalters an der Klinik für Kinder- und Jugendpsychiatrie und –psychotherapie, Neuenhofer Weg 21, 52074, Aachen, Deutschland

    Thomas Günther

  3. Universitätsklinikum Aachen, Lehr- und Forschungsgebiet Klinische Neuropsychologie des Kindes- und Jugendalters an der Klinik für Kinder- und Jugendpsychiatrie und –psychotherapie, Neuenhofer Weg 21, 52074, Aachen, Deutschland

    Kerstin Konrad

  4. Universität Rostock, Klinik und Poliklinik für Psychiatrie und Psychotherapie am Zentrum für Nervenheilkunde, Gehlsheimer Str. 20, 18147, Rostock, Deutschland

    Sabine C. Herpertz

  5. Universitätsklinikum Aachen, Klinik für Kinder- und Jugendpsychiatrie und –psychotherapie, Neuenhofer Weg 21, 52074, Aachen, Deutschland

    Beate Herpertz-Dahlmann

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  1. Timo D. Vloet
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Correspondence to Timo D. Vloet.

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Vloet, T., Günther, T., Konrad, K. et al. Die Bedeutung der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung für die Entstehung und Prognose von Störungen des Sozialverhaltens im Kindes- und Jugendalter. Forens Psychiatr Psychol Krimino 2, 180–189 (2008). https://doi.org/10.1007/s11757-008-0084-6

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