Häufigkeit von Kindern mit vermuteter ADHS im Patientengut von Allgemein- und Kinderärzten im Raum Aachen, sowie Faktoren, die mit einer ADHS assoziiert sind

摘要

Attention-Deficit-Hyperactive-Disorder (ADHD) is one of the most common psychiatric disorders of childhood and adolescence which has been reported with increasing frequency over the past years. The cause of ADHS is multi-factorial. Genetic, as well as prae-, peri- and postnatal factors have been suggested, as have social influences. Anomalies of brain structure and in the physiology of dopamine dependent brain functions have been observed in some children. The diagnosis of ADHD depends on a combination of results from interviews, questionnaire applications, observations and physical examinations. There is no specific anomaly of laboratory parameters or any specific neuro-physiological pattern that could facilitate the diagnosis of ADHD. The therapy of ADHD comprises individually designed measures, usually a combination of an intervention directed at the social environment of the child and the provision of stimulating medicines such as methylphenidate. The study presented here intended to establish the prevalence of children with suspected ADHD among many families residing in the greater Aachen area who present their children to the practice of a general practitioner or paediatrician for any reason. In addition, the study aimed to investigate whether risk or other factors that have been described in the literature as being statistically significantly associated with ADHD can be confirmed for children in Aachen, and whether additional risk factors can be identified. A questionnaire was applied to the parents of children of primary school age in 47 general and paediatric practices in the Aachen area. The questionnaire consisted of the 10-items-Conners Scale. This scale represents the first step in the screening of children in order to arrive at a suspected diagnosis of ADHD, however, it does not permit to arrive at a definite diagnosis. The questionnaire also covered information with respect to leisure activities and sleeping habits, data on actual body weight, birth weight, history of premature delivery and the social background of the children. Questionnaires were distributed to the parents of 600 children. 239 were returned all of which could be evaluated. 15.1% (36) of the children with available information showed =15 points on the Conners-Scale, thus suggesting a possible diagnosis of ADHD. This prevalence may have been subject to selection bias as it is possible that practitioners may have requested parents of hyperactive children more frequently than other parents to fill the questionnaire. In this case children with suspected ADHD might have been over-represented in this study. On the other hand, the proportion of questionnaires completed by parents from an academic professional background was above average (45%), which would imply a possible under-representation of children with suspected ADHD as the disorder was found to be less frequently associated with a higher social background. Statistically significant associations with suspected ADHS have been found for a variety of factors. Boys seemed to have been 4.5-fold more frequently affected than girls. As compared to unaffected children, children with suspected ADHD more often had problems to getting to sleep, spent about double of their past time watching television, and reportedly used TV and/or computer games much more often as their only past time activity. For 28% of the children with suspected ADHD (compared to only 8% of unaffected children), parents reported that they never engaged in sports. It should be noted that this study does not allow conclusions regarding the possible causal links between the factors observed and ADHD. No statistically significant associations were observed with respect to a history of premature delivery, the social background and problems of sleeping through. However, the sample size was small, and with only 36 children with suspected ADHD, the existence of such possible associations cannot be excluded. Further studies with higher sample sizes may answer this question. To the author’s knowledge, this study is the first so far that looked at leisure activities of possible ADHD-children. The results show substantial differences in the quantity and quality of these activities between affected and unaffected children. Further investigations into this aspect could perhaps help to improve behavioural interventions that form part of the therapy of children with ADHD.