Introduction: Recently published reviews and meta-analytic studies have shown increased interest in research of the ADHD and ED comorbidity. We conducted a case-control study (133 ED female patients/93 healthy control), screening for ED among ADHD patients (N=64) and a pilot study of a support group program for adults with ADHD and psychiatric comorbidities. Methods: Adult and childhood ADHD symptoms were assessed by self-report and other- report versions of a Barkley Adult ADHD questionnaire (BAARS-IV). Patients with ED and ADHD comorbidity underwent a structured interview (DIVA 2) and Integrated Visual and Auditory Performance Tests (IVA Plus) to confirm the ADHD diagnosis. Participants of the pilot program were assessed prior to and after the therapy by the Schwartz Outcome Scale (SOS) and Quality of life (SQUALA) questionnaires. Results: Using self-report questionnaire of current symptoms 61 (46 %) of ED patients were detected as likely having ADHD compared to 22 (24 %) from a healthy control group, 37 (28 % ) of ED patients were identified with the high probability of ADHD diagnose compared to 12 (13 %) from a healthy control group with significant differences. Screening for disordered eating behaviors indicated previously documented higher prevalence of overweight among men with ADHD...

<p>Za poremećaje iz grupe koja je u DSM-IV označena pod nazivom Deficit pažnje i poremećaji sa nasilničkim pona&scaron;anjem, a to su Deficit pažnje/Hiperaktivni poremećaj (ADHD), Poremećaj u vidu protivljenja i prkosa (ODD) i Poremećaj pona&scaron;anja (CD), može se reći da kao jedno od svojih osnovnih obeležja imaju i međusobni komorbiditet. I istraživačka praksa i iskustva kliničara ukazuju na to da je za ova tri poremećaja karakteristična tendencija da se javljaju mnogo če&scaron;će u kombinaciji, nego kao zasebni psihopatolo&scaron;ki entiteti.<br />Imajući u vidu čest komorbiditet, a uzimajući u obzir i činjenicu da među autoritetima na području bavljenja problematikom vezanom za poremećaje iz ove grupe ne postoji saglasnost po pitanju međusobnog odnosa ova tri poremećaja (ni u poslednjim izdanjima DSM i ICD klasifikacionih sistema ovi poremećaji ne tretiraju se na isti način), ovim istraživanjem nastojalo se utvrditi u kojoj meri su ADHD, ODD i CD zaista tri jedinstvena i nezavisna složaja pona&scaron;anja, ili se pre mogu tretirati kao jedan op&scaron;tiji psihopatolo&scaron;ki fenomen.<br />Na uzorku od 1471 deteta dve uzrasne kategorije, a prosečnog uzrasta od 9 godina i 4 meseca, primenjene su skale procene prisustva pona&scaron;anja karakterističnih za ADHD, Poremećaj u vidu protivljenja i prkosa i Poremećaj pona&scaron;anja. Skale su popunjavali učitelji dece. Od instrumenata je kori&scaron;ćena i skraćena forma treće revizije Konersove skale koju su popunjavali i učitelji, ali i deca iz starije grupe (sve tri skale kori&scaron;ćene u istraživanju visoke su kriterijumske validnosti). Na osnovu pravila za skorovanje, izdvojena je grupa od 373 dece koja manifestuju bihevioralne indikatore nekog od tri navedena psihopatolo&scaron;ka fenomena ili vi&scaron;e njih istovremeno. Na osnovu analize međusobnih preklapanja ispitivanih entiteta, može se zaključiti da je deficit pažnje, posmatran kao zasebna dimenzija, najmanje komorbidan od svih ispitivanih fenomena. Hiperaktivnost, posmatrana samostalno ili u kombinaciji sa deficitom pažnje, mnogo vi&scaron;e je povezana sa ostalim problemima, nego &scaron;to je to deficit pažnje. Poremećaj pona&scaron;anja i Poremećaj u vidu protivljenja i prkosa gotovo su uvek povezani, ili međusobno ili sa kombinovanim ADHD podtipom, odnosno sa izdvojenom dimenzijom hiperaktivnosti.<br />Rezultati konfirmatorne faktorske analize pokazali su da je model sa najboljim indeksima podesnosti bifaktorski model sa 4 faktora (deficit pažnje, hiperaktivnost, prkosno i suprotstavljajuće pona&scaron;anje i problemi u pona&scaron;anju), &scaron;to bi značilo da četiri izdvojena faktora predstavljaju fenomene koje karakteri&scaron;u pona&scaron;anja specifična za svaki od njih posebno, ali su ta pona&scaron;anja istovremeno i zajednički indikatori jednog generalnog faktora. Hiperaktivnost je u najvećoj meri zajednički fenomen sva tri poremećaja koja su predmet proučavanja u ovom radu, dok je nepažnja u najmanjoj meri zajednička svim poremećajima. U daljem toku statističke obrade podataka, primenjena je analiza latentnih profila. Rezultati ove analize saglasni su sa rezultatima dobijenim na osnovu analize komorbidnih stanja, kao i sa rezultatima konfirmatorne faktorske analize. Deficit pažnje, hiperaktivnost, prkosno i suprotstavljajuće pona&scaron;anje i problemi u pona&scaron;anju predstavljaju bihevioralne dimenzije koje su često povezane, pri čemu je komorbiditet svih navedenih problema zajedno posebno čest, kao i kombinacija hiperaktivnosti i deficita pažnje. Na osnovu svih sprovedenih analiza nameće se zaključak da ADHD, ODD i Poremećaj pona&scaron;anja pre predstavljaju različite dimenzije jednog generalnog psihopatolo&scaron;kog fenomena, nego &scaron;to ih možemo posmatrati kao entitete potpuno nezavisne jedan od drugog.<br />Suprotno postavljenoj hipotezi, uzrast se nije pokazao kao značajan faktor za manifestovanje pona&scaron;anja koja su tipična za Poremećaj u vidu protivljenja i prkosa i Poremećaj pona&scaron;anja. Potvrđena je pretpostavka o tome da deficit pažnje tokom vremena perzistira kod dece i ispoljava se u istoj meri, ali ne i pretpostavka o tome da dolazi do redukcije motornog nemira kako dete biva starije. Deca sa pona&scaron;anjima koja karakteri&scaron;u svaki od tri poremećaja imaju značajno slabije &scaron;kolsko postignuće u odnosu na kontrolnu grupu dece, pri čemu je saznanje o &scaron;kolskom uspehu deteta značajnije povezano sa učiteljskom procenom pona&scaron;anja dece nego sa samoprocenom samih učenika. Gradska sredina pokazala se kao značajan faktor za manifestovanje pona&scaron;anja karakterističnih samo za kombinovani ADHD podtip. Kao varijabla od značaja za ispoljavanje problematičnih pona&scaron;anja, pokazao se obrazovni nivo roditelja, i oca i majke. &Scaron;to su roditelji vi&scaron;eg obrazovnog nivoa, deca u manjoj meri manifestuju pona&scaron;anja koja su tipična za neki od tri poremećaja.<br />Rezultati dobijeni ovim istraživanjem jasno ukazuju na neophodnost posmatranja tri poremećaja iz grupe Deficit pažnje i poremećaji sa nasilničkim pona&scaron;anjem kroz drugačiju prizmu, a ne samo uzimajući u obzir kategorijalni pristup. U daljim istraživanjima problematike deficita pažnje i poremećaja sa nasilničkim pona&scaron;anjem u na&scaron;oj sredini, bilo bi poželjno uzorkom obuhvatiti decu iz vi&scaron;e od dve uzrasne kategorije, kao i decu iz velikih gradova, a svakako da bi uključivanje kliničkog uzorka dece u značajnoj meri doprinelo daljem rasvetljavanju međusobnog odnosa ADHD-a, Poremećaja u vidu protivljenja i prkosa i Poremećaja pona&scaron;anja.</p> / <p>One of the main features for the DSM-IV Attention Deficit and Disruptive Behavior Disorders (Attention Deficit/Hyperactivity Disorder, Conduct Disorder and Oppositional Defiant Disorder) is their mutual comorbidity. Both research and clinical practice showed that ADHD, ODD and CD typically occur in combination and that noncomorbid ODD, ADHD or CD are fairly rare. The overlap between those diagnosis is very well established. Regarding the frequent comorbidity, together with the fact that there is no consensus among authorities in the field (the specific criteria for diagnosing ADHD, ODD or CD vary between the guidelines adopted in the United States &ndash; DSM, and those used in Europe and in other international communities - ICD), one of the aims of this study was to determine whether ADHD, ODD and CD are really three unique and independent behavioral psychopathological entities, or those three can be treated as one more general psychopathological phenomenon.<br />The research was conducted on a convenience sample of N=1471 children (N=760 boys), with an average age of 9 years and 4 months. The presence of characteristics of ADHD, Oppositional Defiant Disorder and Conduct Disorder was measured with three scales &ndash; IVJER, CDRS-IV and ODDRS. These scales have been administrated to teachers. Third revision of the Conners Rating Scale (CRS) was also used in this study &ndash; both teacher report short form and self-report short form. Based on the rules for scoring the rating scales used in this research, a group of 373 children, who exhibit behavioral indicators of one of the three psychopathological phenomena listed above or several of them simultaneously are identified. On the basis of an analysis of the mutual overlapping of the examined entities, it can be concluded that the attention deficit, observed as a separate dimension, is the least comorbid of all the investigated phenomena. Hyperactivity, observed alone or in combination with attention deficit, is much more associate with other problems than attention deficit alone. Conduct Disorder and Oppositional Defiant Disorder are almost always in correlation, either with each other or with a combined ADHD subtype, or with a separate dimension of hyperactivity.<br />The results of the Confirmatory Factor Analysis (CFA) showed that the model with the best goodness-of-fit indices is the bifactor model with 4 factors (attention deficit, hyperactivity, defiant and oppositional behaviors and behavioral problems), which means that four separate factors represent phenomena which are characterized by behaviors specific to each of the factors, but, at the same time, these behaviors are the common indicators of the general factor. Hyperactivity is largely a common characteristic of all three disorders from the group, while attention deficit is at least common to all disorders. The results of the Latent Class Analysis (LCA) are consistent with the results obtained from the analysis of the mutual overlapping of the examined entities, as well as with the CFA results. Attention deficit, hyperactivity, defiant and oppositional behaviors and severe conduct problems are behavioral dimensions which are often in correlation, with the comorbidity of all these problems together being particularly common, along with the combination of hyperactivity and attention deficit. The research findings showed that ADHD, ODD and Conduct Disorder are more likeley to represent the different dimensions of a general psychopathological phenomenon, than being the entities completely independent of each other.<br />In contrast to the hypothesis, age did not prove to be a significant factor in the manifestation of behavior that is typical of Oppositional Defiant Disorder and Conduct Disorder. It is confirmed that attention deficit persists over time in children and is demonstrated to the same extent, but it is not confirmed that there is a reduction in hyperactivity as the child gets older. Children with behaviors that characterize each of the three disorders have significantly lower school achievement than the control group of children, whereby the knowledge about the child&rsquo;s school achievement is significantly more associate with the teacher&#39;s assessment of the child&rsquo;s behavior rather than with the self-evaluation of the students themselves. The urban environment proved to be a significant factor in the manifestation of behavior typical only of the combined ADHD subtype. As a variable of significance for the manifestation of problematic behaviors, the educational level of parents has been demonstrated. It is less likely for children to manifest behaviors that are typical of one of the three disorders, if the parents&rsquo; educational level is higher.<br />The research findings clearly point to the necessity of observing three disorders from the group Attention Deficit and Disruptive Behavior Disorders through a different prism, not just taking into account the categorical approach. The further research in the field of problem behaviors in our community, should include children from more than two age categories, as well as children from large cities. Clinical samples of children will significantly contribute to further clarification of the relation between ADHD, ODD and Conduct Disorder.</p>