نقاشی صورت ساعت در کودکان مبتلا به نقص توجه و اختلال بیش فعالی

The clock drawing test has been found to be sensitive to visual–spatial perception, graphomotor skills, verbal reasoning, and executive functioning in adult patient populations, as well as frontal lobe maturation in normal children. Our study is among the first to assess the use of clock drawing as a neuropsychological measure in the pediatric population. Participants included 41 children with attention-deficit/hyperactivity disorder (ADHD) and 41 normal controls, ages 6–12 years, matched for age, gender, and handedness. Conceptualization of time and construction of the clock face were assessed separately using a scoring system normed on school-age children in an earlier study. Children with Predominantly Inattentive Type were found to perform similarly to those with Combined Type of ADHD. However, children with ADHD, regardless of subtype, performed significantly poorer than controls. Qualitative analysis of performance revealed errors that were subsequent to poor planning during task execution, consistent with executive dysfunction commonly present in children with ADHD. Further, multiple regression analysis demonstrated that a neuropsychological measure of executive functioning was predictive of clock construction performance in children with ADHD. Constructional praxis and receptive vocabulary also were predictive of clock construction ability. Implications of these findings are discussed.

The clock drawing test routinely has been administered as a component of neuropsychological evaluations with adults (Goodglass & Kaplan, 1983 and Strub & Black, 1977). Many investigators report clock drawing to be a measure of visuospatial skills and graphomotor abilities (Goodglass & Kaplan, 1983; Mendez, Ala, & Underwood, 1992; Sunderland et al., 1989), while others state that it also measures aspects of executive functioning (Libon, Malamut, Swenson, Sands, & Cloud, 1996; Royall, Cordes, & Polk, 1998). The clock drawing test requires minimal materials and typically takes less than 5 min to administer. While the simplicity of the task may suggest that it has only limited usefulness, the process utilized in constructing a clock, as well as the errors made, provides valuable information as part of a comprehensive evaluation (Freedman et al., 1994).