Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is characterized as a behavioral syndrome with core symptoms of inattention and/or hyperactivity/impulsivity that constitute, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), predominantly Inattentive and Hyperactive-Impulsive and a combined (additive) presentation that fulfills both criteria. The question remains if the pathophysiological background of both factors is also separate at levels of investigation beyond core symptoms. This would allow a clearer understanding and a more focused treatment approach even with tools derived from these levels. Hence, we assumed that an implicit additive diagnostic model also holds at the levels of associated psychopathology, neuropsychological performance and brain oscillations. We investigated this hypothesis using data of 61 boys (7–12 years old) with ADHD and 43 typically developing children. There were no significant differences in age and IQ between groups. Children were examined with Child Behavior Checklist (CBCL), the Integrated Visual and Auditory Test (IVA), and brain oscillations during eyes closed resting state. Inattention characteristics were associated with more pronounced internalizing problems, lower attention, and vigilance during IVA performance and at the Electroencephalography level with elevated Theta and diminished Beta power during eyes closed rest. In contrast, hyperactivity/impulsivity characteristics led to general psychopathology problems and showed at the neuropsychological level faster response speed and deficits in cognitive control and performance consistency, but were on the electroencephalography level without any deficits in EEG power. Considering differences in behavioral, neuropsychology, and electroencephalography levels in each subtype, separate clinical approaches should be recommended for them and an additive model for their combination.

摘要

注意缺陷多动障碍 (ADHD) 的特征是一种行为综合征，其核心症状是注意力不集中和/或多动/冲动，根据精神障碍诊断和统计手册 (DSM-5)，主要是注意力不集中和多动-冲动和满足这两个标准的组合（附加）表示。问题仍然存在，这两个因素的病理生理学背景是否在核心症状之外的调查水平上也是分开的。即使使用从这些级别派生的工具，这也将允许更清晰的理解和更集中的治疗方法。因此，我们假设隐含的附加诊断模型也适用于相关的精神病理学、神经心理表现和大脑振荡的水平。我们使用 61 名患有 ADHD 的男孩（7-12 岁）和 43 名正常发育的儿童的数据调查了这一假设。各组之间的年龄和智商没有显着差异。用儿童行为检查表 (CBCL)、综合视觉和听觉测试 (IVA) 以及闭眼休息状态下的大脑振荡检查儿童。注意力不集中的特征与更明显的内化问题、较低的注意力和警惕性相关，在 IVA 性能和脑电图水平上，闭眼休息期间的 Theta 升高和 Beta 功率降低。相比之下，多动/冲动特征导致一般的精神病理学问题，并在神经心理学水平上表现出更快的反应速度和认知控制和表现一致性的缺陷，但在脑电图水平上没有任何脑电图功率缺陷。考虑到每个亚型在行为、神经心理学和脑电图水平上的差异，应该为它们推荐单独的临床方法，并为它们的组合推荐一个附加模型。