Causal heterogeneity in attention-deficit/hyperactivity disorder: Do we need neuropsychologically impaired subtypes?
Causal heterogeneity in attention-deficit/hyperactivity disorder: Do we need neuropsychologically impaired subtypes?
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DOI：
10.1016/j.biopsych.2004.08.025
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发表时间：
2005-06-01
影响因子：
10.6
通讯作者：
Sonuga-Barke, EJS
中科院分区：
文献类型：
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作者：
Nigg, JT;Willcutt, EG;Sonuga-Barke, EJS
在给精神病理障碍赋予完全的病因学有效性之前，必须确定影响个体的机制中的疾病理论。现有的关于注意力缺陷/多动障碍（ADHD）的理论表明，这些障碍存在于儿童的认知、神经心理或动机过程中。迄今为止，研究人员已经通过比较dsm定义的ADHD组和非ADHD组来测试这些理论。本文以执行功能为例，说明存在于所有这类理论中的一个问题，描述了群体绩效数据中的大量重叠。因此，只有一个小组可能有执行缺陷。值得注意的是其他支持性数据表明多动症有多种途径。这篇文章探讨了影响，并建议未来的理论和研究更多地考虑到只有一小部分行为定义的儿童在特定的神经认知机制中存在缺陷的可能性，这种缺陷被认为是导致这种障碍的原因。在DSM-V中创建一套临时标准来定义“执行缺陷类型”，可以刺激研究来验证ADHD的第一种病因亚型，并刺激更复杂的因果模型的发展，从长远来看，这可能会给临床医生提供针对性和量身定制治疗的方法。
Before assigning full etiologic validity to a psycopathologic disorder, disease theory in a mechanism within the affect individuals must be identified. Existing theories on attention-deficit/hyperactivity disorder (ADHD) suggest such dysfunctions in cognitive, neuropsychological, or motivational processes in the child. To date, researchers have tested these theories by comparing groups with DSM-defined ADHD to children without ADHD. Using executive functioning as an illustration of an issue that exists across all such, theories, this article describes substantial overlaps in the group performance data. Thus only a subgroup may have executive deficits. Noted are other supportive data suggesting multiple pathways to ADHD. The article explores implications and recommends that future theory and research give more consideration to the probability that only a subset of behaviorally defined children will have a deficit in a given neurocognitive mechanism believed to contribute to the disorder. Creation of a provisional set of criteria in DSM-V for defining an "executive deficit type" could stimulate research to validate the first etiologic subtype of ADHD and spur the development of more sophisticated causal models, which in the longer term may give clinicians ways to target and tailor treatments.