Dikkat Eksikliği ve Hiperaktivite Bozukluğu Tanılı Çocuk ve Ergenlerde Yürütücü İşlev Sorunları ve Tedavisi

Abstract

Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB) çocuk ve gençlerin evleri, okulları ve toplum içindeki işlevselliğini ciddi bir şekilde etkileyen nöro-gelişimsel bir bozukluktur. Son yıllarda DEHB’nin altta yatan sebebinin yürütücü işlev bozukluğu ile ilgili olduğu hipotezler ortaya konulmuştur. Bu hipotezlerin sonucu olarak hem performansa dayalı ölçümlerle, hem de ebeveyn ve öğretmenlere dayalı ölçekler aracılığıyla DEHB’de hangi yürütücü işlev bozukluklarının görüldüğü araştırılmaya başlanmıştır. DEHB'de yürütücü işlev sorunlarının değerlendirilmesinde birçok yöntem bulunmaktadır. Ayrıca, DEHB'ye yürütücü işlev sorunlarının eşlik ettiği durumların tedavisinde uygulanan bazı ilaç ve ilaç dışı tedavi yaklaşımları mevcuttur. Bu yazının amacı, dikkat eksikliği hiperaktivite bozukluğundaki yürütücü işlev sorunları ve tedavisini gözden geçirmektir. 

Keywords

• Dikkat eksikliği ve hiperaktivite bozukluğu,yürütücü işlevler

Executive Function Problems and Treatment in Children and Adolescents with Attention Deficit and Hyperactivity Disorder

Abstract

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that may seriously affect youth’s home, school, and social functioning. In recent years, hypotheses have been put forward that the underlying cause of ADHD is related to executive function impairments. As a consequence of these hypotheses,  executive dysfunctions  seen in ADHD were started to be evaluated through both performance-based measures and scales based on parents and teachers. There are many methods for assessing executive function in attention deficit hyperactivity disorder. Also, there are several pharmacological and non-pharmacological treatment approaches available in treatment of executive function problems among patients with attention deficit hyperactivity disorder. The aim of this article is to review the impact of executive function in attention deficit hyperactivity disorder and its treatment. 

Keywords

• Attention deficit and hyperactivity disorder,executive function

References

1. Adler LA, Clemow DB, Williams DW, Durell TM (2014) Atomoxetine effects on executive function as measured by the BRIEF-A in young adults with ADHD: A randomized, double-blind, placebo-controlled study. PLoS One, 9(8): e104175.
2. Akgün GM, Tufan AE, Yurteri N, Erdoğan E (2011) Dikkat eksikliği hiperaktivite bozukluğunun genetik boyutu. Psikiyatride Güncel Yaklaşımlar, 3:15-48.
3. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. Fifth Ed. Washington: American Psychiatric Publishing. Anderson P (2002) Assessment and development of executive function during chilhood. Child Neuropsychol, 8(2):71-82.
4. Anderson P (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychol, 8:71-82.
5. Banerjee TD, Middleton F, Faraone SV (2007) Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr, 96(9):1269-1274.
6. Barkley R (2012) Executive Functions: What They Are, How They Work and Why They Evolved. Newyork : Guilford Press.
7. Barkley RA (1997) Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull, 121(1):65-94.
8. Beck SJ, Hanson CA, Puffenberger SS, Benninger KL, Benninger WB (2010) A controlled trial of working memory training for children and adolescents with ADHD. J Clin Child Adolesc Psychol, 39(6):825-836.

9. Berlin L, Bohlin G, Nyberg L, Janols LO (2004) How well do measures of inhibition and other executive functions discriminate between children with ADHD and controls? Child Neuropsychol, 10(1):1-13.
10. Biederman J, Faraone SV, Mick E, Williamson S, Wilens TE, Spencer TJ, et al. (1999) Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources. J Am Acad Child Adolesc Psychiatry, 38:966-975.
11. Brown TE (2008) ADD/ADHD and impaired executive function in clinical practice. Curr Psychiatry Rep, 10(5):407-411.Bussing R, Lebninger F, Eyberg S (2006) Difficult child temperament and attentiondeficit/hyperactivity disorder in preschool children. Infants Young Child, 19:123-131.
12. Castellanos FX, Giedd JN, Berquin PC, Walter JM, Sharp W, Tran T et al. (2001) Quantitative brain magnetic resonance imaging in girls with attention deficit/ hyperactivity disorder. Arch Gen Psychiatry, 58:289-295.
13. Chacko A, Feirsen N, Bedard AC, Marks D, Uderman JZ, Chimiklis A (2013) Cogmed Working Memory Training for Youth with ADHD: A closer examination of efficacy utilizing evidence-based criteria. J Clin Child Adolesc Psychol, 42(6):769-783.
14. Chien-Yu P, Chia-Liang T, Chia-Hua C, Ming-Chih S, Chu-Yang H, Wei-Ya M (2015) Effects of physical exercise intervention on motor skills and executive functions in children with ADHD: A Pilot Study. J Atten Disord, 1-14. Chung HJ, Weyandt LL, Swentosky A (2014) The Physiology of Executive Functioning. Handbook of Executive Functioning, 13-27.
15. Coghill DR, Seth S, Pedroso S, Usala T, Currie J, Gagliano A (2013) Effects of methylphenidate on cognitive functions in children and adolescents with attention-deficit/ hyperactivity disorder: evidence from a systematic review and a meta-analysis. Biol Psychiatry, 76:603-615.
16. Cortese S, Ferrin M, Brandeis D, Buitelaar J, Daley D, Dittmann RW, et al. (2015) Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry, 54(3):164-174.
17. Delis DC, Kramer JH, Kaplan E, Holdnack J (2004) Reliability and validity of the Delis-Kaplan Executive Function System: An update. J Int Neuropsychol Soc, 10:301-303.
18. Dentz A, Guay MC, Parent V, Romo L (2017) Working memory training for adults with ADHD. J Atten Disord, 1:1087054717723987.
19. Diamond A (2013) Executive Functions. Annu Rev Psychol, 64:135-168.
20. Dishman RK, Berthound HR, Booth FW, Cotman CW, Edgerton VR, Fleshner MR, et al. (2006) Neurobiology of exercise. Obesity, 14:345-355.
21. Ercan ES (2010) Dikkat eksikliği hiperaktivite bozukluğunda epidemiyolojik veriler. Turkiye Klinikleri Pediatrik Bilimler Dergisi, 6(2):1-5.
22. Froehlich TE, Anixt JS, Loe IM, Chirdkiatgumchai V, Kuan L, Gilman RC (2011) Update on environmental risk factors for Attention-Deficit/Hyperactivity Disorder. Curr Psychiatry Rep, 13(5):333-344.
23. Garon N, Bryson SE, Smith IM (2008) Executive function in preschoolers: a review using an integrative framework. Psychol Bull, 134(1):31-60.
24. Geurts HM, Verté S, Oosterlaan J, Roeyers H, Sergeant JA (2005) ADHD subtypes: do they differ in their executive functioning profile? Arch Clin Neuropsychol, 20(4):457-477.
25. Gioia GA, Isquith PK, Guy SC, Kenworthy L (2000). The Behavior Rating Inventory of Executive Function. Child Neuropsychol, 6(3):235-238.
26. Goldberg MC, Mostofsky SH, Cutting LE, Mahone EM, Astor BC, Denckla MB, et al. (2005) Subtle executive impairment in children with autism and children with ADHD. J Autism Dev Disord, 35(3):279-293.
27. Gray SA, Chaban R, Martinussen R, Goldberg H, Gotlieb R, Kronitz Ret al. (2012) Effects of a computerized working memory training program on working memory, attention, and academics in adolescents with severe LD and comorbid ADHD: A randomized clinical trial. J Child Psychol Psychiatry, 53:1277-1284.
28. Green CT, Long DL, Green D, Iosif A, Dixon F, Miller MR, et al. (2012) Will working memory training generalize to improve off-task behavior in children with attentiondeficit/hyperactivity disorder? Neurotherapeutics, 9(3): 639-648.
29. Henry L, Bettenay C (2010) The assessment of executive functioning in children. Child Adolesc Ment Health, 15(2):110-119.
30. Houghton S, Douglas G, West J, Whiting K, Wall M, Langsford S, et al. (1999) Differential patterns of executive function in children with attention-deficit hyperactivity disorder according to gender and subtype. J Child Neurol, 14(12):801-805.
31. Ince Tasdelen B, Karakaya E, Oztop DB (2015) Effects of atomoxetine and osmotic release oral system-methylphenidate on executive functions in patients with combined type Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol, 25(6):494-500.
32. Klingberg T (2010) Training and plasticity of working memory. Trends Cogn Sci, 14(7):317-324.
33. Klingberg T, Forssberg H, Westerberg H (2002) Training of working memory in children with ADHD. J Clin Exp Neuropsychol, 24(6):781-791.
34. Lawrence V, Houghton S, Douglas G, Durkin K, Whiting K, Tannock R (2004) Executive function and ADHD: a comparison of children's performance during neuropsychological testing and real-world activities. J Atten Disord, 7(3):137-149.
35. Logue S, Gould TJ (2014) The neural and genetic basis of executive function: Attention, cognitive flexibility, and responce inhibition. Pharmacol Biochem Behav, 123:45-54.
36. Luciana M (2003) Practitioner Review: Computerised assessment of neuropsychological function in children: Clinical and research applications of the Cambridge Neuropsychological Testing Automated Battery (CANTAB). J Child Psychol Psychiatry, 44:649-663.
37. Manly T, Anderson V, Nimmo-Smith I, Turner A, Watson P, Robertson IH (2001) The differential assessment of children's attention: The Test of Everyday Attention for Children (TEA -Ch), normative sample and ADHD performance. J Child Psychol Psychiatry, 42:1065-1081.
38. Martinussen R, Hayden J, Hogg-Johnson S, Tannock R (2005) A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry, 44(4):377-384.
39. Memarmoghaddam M, Torbati H, Sohrabi M, Mashhadi A, Kashi A (2016) Effects of a selected exercise program on executive function of children with attention deficit hyperactivity disorder. J Med Life, 9(4):373-379.
40. Nigg JT, Blaskey LG, Huang-Pollock CL, Rappley MD (2002) Neuropsychological executive functions and DSM-IV ADHD subtypes. J Am Acad Child Adolesc Psychiatry, 41(1):59-66.
41. Öncü B, Şenol S (2002) Dikkat eksikliği ve hiperaktivite bozukluğunun etiyolojisi: Bütüncül yaklaşım. Klinik Psikiyatri Dergisi, 5:111-119.
42. Oosterlaan J, Scheres A, Sergeant JA (2005) Which executive functioning deficits are associated with AD/HD, ODD/CD and comorbid AD/HD+ODD/CD? J Abnorm Child Psychol, 33(1):69-85.
43. Polanczyk G, De Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry, 164:942-948.
44. Qian Y, Shuai L, Cao Q, Chan RC, Wang Y (2010) Do executive function deficits differentiate between children with attention deficit hyperactivity disorder (ADHD) and ADHD comorbid with oppositional defiant disorder? A cross-cultural study using performance-based tests and the behavior rating inventory of executive function. Clin Neuropsychol, 24(5):793-810.
45. Rapport MD, Orban SA, Kofler MJ, Friedman LM (2013) Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clin Psychol Rev, 33:1237-1252.
46. Riccio CA, Homack S, Jarratt KP, Wolfe ME (2006) Differences in academic and executive function domains among children with ADHD Predominantly Inattentive and Combined Types. Arch Clin Neuropsychol, 21(7):657-667.
47. Roche JD, Johnson BD (2014) Cogmed working memory product review. J Atten Disord, 18(4):379-384.
48. Rubia K, Alegría AA, Brinson H (2014) Brain abnormalities in attention-deficit hyperactivity disorder: a review. Rev Neurol, 58(1):3-16.
49. Sergeant JA, Geurts H, Oosterlaan J (2002) How specific is a deficit of executive functioning for attention-deficit/hyperactivity disorder? Behav Brain Res, 130(1-2):3-28.
50. Skogli EW, Teicher MH, Andersen PN, Hovik KT, Øie M (2013) ADHD in girls and boys--gender differences in co-existing symptoms and executive function measures. BMC Psychiatry, 13:298.
51. Skounti M, Philalithis A, Galanakis E (2007) Variations in prevalence of attention deficit hyperactivity disorder worldwide. Eur J Pediatr, 166:117-123.
52. Smith AL, Hoza B, Linnea K, McQuade JD, Tomb M, Vaughn AJ, et al. (2013) Pilot physical activity intervention reduces severity of ADHD symptoms in young children. J Atten Disord,17(1):70-82.
53. Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M (2013) Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry, 170:275-289.
54. Tamminga H, Reneman L, Huizenga H, Geurts H (2016) Effects of methylphenidate on executive functioning in attention-deficit/hyperactivity disorder across the lifespan: A meta-regression analysis. Psychol Med, 46(9):1791-1807.
55. Tannock R (1998) Attention deficit hyperactivity disorder: advances in cognitive neurobiological and genetic research. J Child Psychol Psychiatry, 34:65-99.
56. Ter-Stepanian M, Grizenko N, Cornish K, Talwar V, Mbekou V, Schmitz N, et al. (2017) Attention and executive function in children diagnosed with Attention Deficit Hyperactivity Disorder and comorbid disorders. J Can Acad Child Adolesc Psychiatry 2017; 26(1):21-30.
57. Toplak ME, Bucciarelli SM, Jain U, Tannock R (2009) Executive functions: performance- based measures and The Behaviour Rating Inventory of Executive Function (BRIEF) in adolescent with ADHD. Child Neuropsychol, 15(1):53-72.
58. Toplak ME, West RF, Stanovich KE (2013) Practitioner Review: Do performance-based measures and ratings of executive function assess the same construct. J Child Psychol Psychiatry, 54(2):131-43.
59. van Goozen SH, Cohen-Kettenis PT, Snoek H, Matthys W, Swaab-Barneveld H, van Engeland H (2004) Executive functioning in children: a comparison of hospitalised ODD and ODD/ADHD children and normal controls. J Child Psychol Psychiatry, 45(2):284-292.
60. Verret C, Guay MC, Berthiaume C, Gardiner P, Beliveau LA (2012) Physical activity program improves behavior and cognitive functions in children with ADHD: An exploratory study. J Atten Disord, 16:71-80.
61. Vinogradov S, Fisher M, de Villers-Sidani E (2012) Cognitive training for impaired neural systems in neuropsychiatric illness. Neuropsychopharmacol, 37:43-76.
62. Wehmeier PM, Schacht A, Ulberstad F, Lehmann M, Schneider-Fresenius C, Lehmkuhl G, et al. (2012) Does atomoxetine improve executive function, inhibitory control, and hyperactivity? Results from a placebo-controlled trial using quantitative measurement technology. J Clin Psychopharmacol, 32(5):653-60.
63. Westerberg H, Hirvikoski T, Forssberg H, Klingberg T (2014) Visuo-spatial working memory span: a sensitive measure of cognitive deficits in children with ADHD. Child Neuropsychol, 10(3):155-161.
64. Wright I, Waterman M, Prestcott H, Murdoch-Eaton D (2003) A new Strooplike measure of inhibitory function development: Typical developmental trends. J Child Psychol Psychiatry, 44:561-557.
65. Wu KK, Anderson V, Castiello U (2002) Neuropsychological evaluation of deficits in executive functioning for ADHD children with or without learning disabilities. Dev Neuropsychol, 22(2):501-531.
66. Yang L, Cao Q, Shuai L, Li H, Chan RC,Wang Y (2012) Comparative study of OROS-MPH and atomoxetine on executive function improvement in ADHD: A randomized controlled trial. Int J Neuropsychopharmacol, 1501:15-26.
67. Yıldız O, Sismanlar SG, Memik NC, Karakaya I, Agaoglu B (2011) Atomoxetine and methylphenidate treatment in children with ADHD: The efficacy, tolerability and effects on executive functions. Child Psychiatry Hum Dev, 423:257-269.
68. Yılmaz A, Gökçen C, Fettagolu EÇ, Ozatalat E (2013) The effect of methylphenidate on executive functions in children with Attention-Deficit Hyperactivity Disorder. Bull Clin Psychopharmacol, 23(2):162-70.