ISSN : 1229-067X
본 연구에서는 ADHD 아동에게서 나타난 실행기능 결함이 성인 ADHD 환자들에게서도 나타날 것이라는 가설을 검증하였다. 임상척도를 이용하여 성인 ADHD 환자의 임상적 특성인 충동성, 우울, 불안, 자존감을 조사하였고, 구조적 임상 인터뷰를 통하여 공존정신장애를 검사하였다. 신경 심리 검사를 통하여 주의력, 인지기능 및 실행 기능을 조사하였다. 이를 위해 대학병원의 성인 ADHD 외래 진료병동에서 치료를 받고 있는 성인 ADHD 환자 26명과, 성별, 나이, 교육 정도가 실험군과 일치하는 21명의 통제군이 실험에 참가하였다. 연구결과 성인 ADHD 환자는 정상 통제군과 비교하여 우울, 불안, 충동성에서 건강한 통제군보다 더 높은 증상을 보였고 더 낮은 자존감을 보였다. 신경심리검사에서는 ADHD 환자군이 주의력, 기억력, 언어 유창성, 심리 운동적 행동 등 실행기능에서 가설과 달리 통제군과 유의미한 차이를 보이지 않았다. 이 결과에 대해 몇 가지 논의점이 기술되었으며, 제한점과 추후 연구에 대한 제안을 논의하였다.
The purpose of this study is to test clinical symptoms and executive functions of adult ADHD patients. The hypothesis is that adult ADHD patients show higher clinical symptoms and lower performance in executive functions as children with ADHD show deficits in those functions. Method: Twenty-five ADHD patients and twenty-one healthy control subjects with matching age, gender and education participated in the study. They were tested in clinical symptoms like impulsivity, depression, anxiety, and self esteem, and executive functions. We analyzed the symptoms and performance in executive functions. Results: With regard to the clinical symptoms the adult ADHD patient showed severer clinical symptoms, but in contrast to our hypothesis they exhibited no neuropsychological deficits in attenion, memory, verbal fluency, psychomotoric behavior, and IQ, compared to the healthy control. The implications and limitations of this results are discussed.
Arffa, S., Lovell, M., Podell, K., & Goldberg, E. (1998). Wisconsin card sorting test performance in above average and superior school children: Relationship to intelligencen and age. Archives of Clinical Neuropsychology, 13(8), 713-720.
Arffa, S. (2007). The relationship of intelligence to executive function and non-executive function measures in a sample of average, above average, and gifted youth. Archives of Clinical Neuropsychology, 22, 969-978.
Amen, D. G.. & Carmichael, B. D. (1997) High- resolution brain SPECT imaging in ADHD. Ann Clin Psychiatry, 9(2), 81-6.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65-94.
Barkley, R. A. (1998). Attention Deficit Hyperactivity Disorder. New York: The Guilford Press.
Benton, A. L., & Hamsher, K. (1989). Multilingual Aphasia Examination. Iowa City: AKA Associates.
Biederman, J., Petty, C. R., Fried, R., Doyle, A. E., Spencer, T., Seidman, L. J., Gross, L., Poetzl, K., & Faraone, S. V. (2007). Stability of executive function deficits into young adult years: a prospective longitudinal follow-up study of grown up males with ADHD. Acta Psychiatr Scand, 116(2), 129-36.
Cantwell, D. P. (1996). Attention deficit disorder: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry, 35, 978-987.
Casey, B. J., Castellanos, F. X., Giedd, J. N., Marsh, W. L., Hamburger, S. D., Schubert, A. B., Vauss, Y. C., Vaituzis, A. C., Dickstein, D. P., Sarfatti, S. E., & Rapoport, J. L. (1997). Implication of right frontostriatal circuitry in response inhibition and attention- deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry, 36, 374-383.
Castellanos, F. X., Giedd, J. N., Marsh, W. L., Hamburger, S. D., Vaituzis, A. C., Dickstein, D. P., Sarfatti, S. E., Vauss, Y. C., Snell, J. W., Lange, N., Kaysen, D., Krain, A. L., Ritchie, G. F., Rajapakse, J. C., & Rapoport, J. L. (1996). Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder. Arch Gen Psychiatry, 53, 607-616.
Castellanos, F. X., Lee, P. P., Sharp, W. (2002). Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. JAMA, 288, 1740-1748.
Cattell, R. B. (1963). Theory of fluid and crystallized intelligence: A critical Experiment. Educ Psychol 54, 1-22.
Clark, L., Blackwell, A. D., Aron, A. R., Turner, D. C., Dowson, J., Robbins, T. W., & Sahakian, B. J. (2007). Association between response inhibition and working memory in adult ADHD: A link to right frontal cortex pathology? Biol. Psychiatry, 61, 1395-1401.
Cohen, J. D., Forman, S. D., & Braver, T. S. (1994). Activation of the prefrontal cortex in nonspatial working memory task with functional MRI. Human Brain Mapping, 1, 293-304.
Conners, C. K., Erhardt, D., & Sparrow, E. P. (1999). Conners`Adult ADHD Rating Scales (CAARS): Technical Manual. MHS.
Corrigan, J. D., & Hinkeldey, N. S. (1987). Relationships between Part A and B of the Trail Making Test. Journal of Clinical Psychology, 43, 402-408.
Dougherty, D. D., Bonab, A. A., Spencer, T. J., Rauch, S. L., Madras, B. K., Fischman, A. J. (1999). Dopamine transporter density is elevated in patient with ADHD. Lancet, 354, 2132-2133.
Downey, K. K., Stelson, F. W., Pomerleau, O. F., & Giordani, B. (1997). Adult attention deficit hyperactivity disorder: Psychological test profiles in a clinical population. The Journal of Nervous and Mental Disorder, 185(1), 32-38.
Epstein, J. N., Conners, C. K., Sitarenios, G., & Erhardt, D. (1998). Continuous performance test results of adults with attention deficit hyperactivity disorder. The Clinical Neuropsychologist, 12(2), 155-168.
Epstein, J. N., Johnson, D. E., Varia, I. M., & Conners, C. K. (2001). Neuropsychological assessment of response inhibition in adults with ADHD. Journal of Clinical and Experimental Neuropsychology, 23(3), 362-371.
Faraone, S. V., Biederman, J., Doyle, A., Murray, K., Petty, C., Adamson, J. J., & Seidman, L. (2006). Neuropsychological studies of late onset and subthreshold diagnoses of adult attention-deficit/hyperactivity disorder. Biol. Psychiatry, 60, 1081-1087.
Hautzinger, M., & Bailer, M. (1996). Inventar Depressiver Symptome. Weinheim: Beltz Test.
Heiligenstein, E., Conyers, L. M., Berns, A. R., Miller, M. A., & Smith, M. A. (1998). Preliminary normative data on DSM-IV attention deficit hyperactivity disorder in college students. J Am Coll Health, 46, 185- 188.
Hervey, Y., Epstein, J. N., & Curry, J. F. (2004). Neuropsychology of adults with attention- deficit/hyperactivity disorder: A Meta-Analytic Review. Neuropsychology, 18 (3), 485-503.
Holdnack, J. A., Moberg, P. J., Arnold, S. E., Gur, R. C., & Gir. R. E. (1995). Speed of processing and verbal learning deficits in adults diagnosed with attention deficit disorder. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 8(4), 282-292.
Jenkins, M., Cohen, R., Malloy, P., Salloway, S., Johnson, E. G., Penn, J., & Marcotte, A. (1998). Neuropsychological Measures which discriminate among adults with residual symptoms of attention deficit disorder and other attentional complaints. The Clinical Neuropsychologist, 12(1), 74-83.
Johnson, D. E., Epstein, J. N., Waid, L. R., Latham, P. K., Voronin, K. E., & Anton, R. F. (2001). Neuropsychological performance deficits in adults with attention deficit/ hyperactivity disorder. Archives of Clinical Neuropsychology, 16, 587-604.
Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organisation Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med, 35 (2), 245- 56.
Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., & Howes, M. J. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the national comorbidity survey replication. Am J Psychiatry, 163(4),716-723.
Kronfol, Z., Hamsher, K., Digre, K., & Waziri, R. (1978). Depression and hemispheric functions: Changes associated with unilateral ECT. British Journal of Psychiatry, 132, 560-567.
Laux, L., Glanzmann, P., Schaffner, P., & Spielberger, C. D. (1981). Das State-Trait- Angstinventar: Theoretische Grundlagen und Handanweisung. Göttingen: Beltz Test
Lehrl, S. (1995). Mehrfach Wortschatz Intelligenztest. Perimed-spitta.
Lezak, M. D. (1982). The test-retest stability and reliability of some tests commonly used in neuropsychological assessment. Paper presented at the 5thEuropean conference of the International Neuropsychological Society, Deauville, France.
Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M. (1998). Adult psychiatric status of hyperactive boys grown up. Am J Psychiatry, 155, 493-498.
McLean, A., Dowson, J., Toone, B., Young, S., & Bazanis, E. (2004). Characteristic neurocognitive profile associated with adult attention-deficit/hyperactivity disorder. Psychological Medicine, 34, 681-692.
Miceli, G., Caltagirone, C., Gainotti, G., Fasullo, C., & Silveri, M.C. (1981). Neuro- psychological correlates of localized cerebral lesions in nonaphasic brain-damaged patients. Journal of Clinical Neuropsychology, 3, 53-56.
Miller, W. R., & Saucedo, C. F. (1983). Assessment of neuropsychological impairment and brain damage in problem drinkers. In C. J. Golden et al. (Eds.), Clinical neuropsychology: Interface with neurologic and psychiatric disorders. New York: Grune & Stratton.
Miller, R. E., Shapiro, A. P., King, H. E., et al. (1984). Effect of antihypertensive treatment on the behavioral consequences of elevated blood pressure. Hypertension, 6, 202-208.
Murphy, K., & Barkley, R. (1996). Prevalence of DSM-IV symptoms of ADHD in adult licensed drivers: Implications for clinical diagnosis. J Atten Disord, 1, 147-161.
Murphy, P. (2002). Cognitive functioning in adults with Attention-Deficit/Hyperactivity Disorder. Journal of Attention Disorders, 5(4),203-209.
Müller, B. W., Gimbel, K., Keller-Pließnig, A., Sartory, G., Gastpar, M., & Davids, E. (2007) Neuropsychological assessment of adult patients with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci, 257, 112-119.
Parsons, E. J. C.(1984). An Investigation of appropriate neuropsychological assessment procedures with adults in the higher intelligence ranges. Dissertation Abstracts International, 45(5), 1592-B.
Patton, J. H., Stanford, M. S., & Barrat, E. S. (1995). Factor structure of the Barrat impulsiveness scale. Journal of Clinical Psychology, 51,768-774.
Rapport, L. J., VanVoorhis, A., Tzelepis, A., & Friedman, S. R. (2001). Executive functioning in adult attention-deficit hyperactivity disorder. The Clinical Neuropsychologist, 15(4), 479-491.
Reitan, R. M. (1958). Validity of the trail making test as an indication of organic brain damage. Perceptual and Motor Skills, 8, 271-276.
Retz-Junginger, P., Retz, W., Blocher, D., Weijers, H. G., Trott, G. E., Wender, P. H., & Rösler, M. (2002). Wender Utah Rating Scale (WURS-K): Die deutsche Kurzform zur retrospektiven Erfassung des hyperkinetischen Syndroms bei Erwachsenen. Nervenarzt, 73, 830-838.
Reuter, M., Kirsch, P., & Henning, J. (2006). Inferring candidate genes for attention deficit hyperactivity disorder (ADHD) assessed by the World Health Organization Adult ADHD Self-Report Scale (ASRS). J Neural Transm, 113(7), 929-38.
Riccio, C. A., Hall, J., Morgan, A., Hynd, G. W., Gonzalez, J. J., & Marshall, R. M. (1994). Executive function and the Wisconsin Card Sorting Test: Relationship with behavioral ratings and cognitive ability. Developmental Neuropsychology, 10(3), 215-229.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
Rösler, M., Retz, W., Retz-Junginger, P., Thome, J., Supprian, T., Nissen, T., Stieglitz, R. D., Blocher, D., Hengesch, G., & Trott, G. E. (2004). Instrumente zur Diagnostik der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter. Der Nervenarzt, 75 (9), 888-895.
Santosh, P. J., & Taylor, E. (2000). Stimulant drugs. European Child & Adolescent Psychiatry, 9: I/27-I/43.
Seidman, L. J., Biederman, J., Weber, W., Hatch, M., & Faraone, S. V. (1998). Neuro- psychological function in Adults with Attention Deficit Hyperactivity Disorder. Society of Biological Psychiatry, 260-268.
Shekim, W. O., Asarnow, R. F., Hess, E., Zaucha, K., & Wheeler, N. (1990). A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state. Comprehensive Psychiatry, 31(5), 416-425.
Snow, W. G., Tierney, M. C., & Zorzitto, M. L.(1988). One-year test-retest reliability of selected neuropsychological tests in older adults (abstract). Journal of Clinical and Experimental Neuropsychology, 10, 60.
Sobanski, E. (2006). Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci, 256(Suppl.1), 26-31.
Spreen, O., & Benton, A. L. (1977). Neurosensory Center Comprehensive Examination for Aphasia: Manual of Directions. Revised Edition. Victoria, BC, Canada, Neuropsychology Laboratory, University of Victoria.
Spreen, O., & Strauss, E. (1991). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. New York: Oxford University Press.
Swanson, J. M., Sergeant, J. A., Taylor, E., Sonuga-Barke, E. J., Jensen, P. S., & Cantwell, D. P. (1998). Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet, 351, 429-433.
Walker, A. J., Shores, E. A., Trollor, J. N., Lee, T., & Sachdev, P. S. (2000). Neuropsychological functioning of adults with attention deficit hyperactivity disorder. Journal of Clinical and Experimental Neuropsychology, 22(1), 115-124.
Ward, M. F., Wender, P. H., & Reimherr, F. W. (1993). The Wender Utah Rating Scale: An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry, 150, 885-890.
Welsh, M. C., & Pennington, B. F. (1988). Assessing frontal lobe functioning in children: Views from developmental psychology. Developmental Neuropsychology, 4, 199-230.
Welsh, M. C., Pennington, B. F., & Groisser, B. B. (1991). A normative-developmental study of executive function: a window on prefrontal function in children. Dev Neuropsychol, 7, 131 -149.
Weißner, B., & Felber, W. (1981). Agreement between 2 diagnostic intelligence test procedures (HAWIE and MWT-B) in a sample of patients with pronounced psychopathology. Psychiatr Neurol Med Psychol, 33(12), 744-8.
Wittchen, H. U., Zaudig, M., & Fydrich, T. (1997). SKID. Strukturiertes Klinisches Interview für DSM-IV. Achse I und II. Göttingen: Hogrefe.
Woods, S. P., Lovejoy, D. W., & Ball, J. D. (2002). Neuropsychological characteristics of adults with ADHD: A comprehensive review of initial studies. The Clinical Neuropsychologist, 16(1), 12-34.
Zametkin, A. J., Nordahl, T. E., Gross, M., King, A. C., Semple, W. E.,, Rumsey, J., Hamburger, S., & Cohen, R. M. (1990). Cerebral glucose metabolism in adults with hyperactivity of childhood onset. The new england journal of medicine, 323, 1361-1366.
Zametkin, A. J., & Rapoport, J. L. (1986). The pathophysiology of attention deficit disorder with hyperactivity: a review. Advances in clinical child psychology, 9, 177-216.
Zimmermann, P., & Fimm, B. (2002). Testbatterie zur Aufmerksamkeits-prüfung (TAP).