مشخصات حرکتی کودکان مبتلا به اختلال بیش فعالی و کمبود توجه، نوع ترکیبی

Objectives The aim of this study was to assess the motor profile of children with attention deficit hyperactivity disorder (ADHD), combined type. Method The case group consisted of 34 treatment-naive, male patients, aged 7–11 years, who had been diagnosed with ADHD, combined type, without comorbidities (except oppositional defiant disorder). The control group was composed of 32 age- and gender-matched, typically developing children. The evaluation was made using the Motor Development Scale, which assessed global and fine motricity, balance, body scheme, and spatial and temporal organization. Results The results showed that the motor quotients in all areas studied were lower in the ADHD group than in the control group, although in most cases they represent normal values relative to the scale (53% were classified as having “normal medium” motor development, 29% “normal low”, 9% “very low”, 6% “normal high” and 3% as “lower”). Statistically significant differences between groups were observed in general motor age, general motor quotient, balance, spatial organization, and fine and global motricity. Conclusion Difficulties in motor performance were observed in the children with ADHD, combined type. The identification of such deficits may assist in the design of therapeutic protocols for the treatment of children with this type of ADHD.

Attention deficit hyperactivity disorder (ADHD) is characterized by the inappropriate development of activity level, low tolerance for frustration, impulsivity, distractibility, and the inability to sustain attention and concentration. Inattentiveness is the limited ability to remain attentive for the time needed to perform or understand a certain task; hyperactivity is characterized by excessive motor activity and impulsiveness in children, and is manifested in sudden and unthinking reactions. Both accompany ADHD ( American Psychiatric Association, 2000 and Barkley, 2003). ADHD is the most common neurobehavioral disorder during childhood, affecting approximately 3–6% of school-aged children (Polanczyk et al., 2007 and Rohde and Halpern, 2004). The estimated prevalence of ADHD worldwide is 5.29%. It occurs more often in boys than in girls, and commonly presents comorbidity with other neurological and psychiatric diseases (Barkley, 2003 and Polanczyk et al., 2007). A substantial proportion (approximately half) of clinic-referred children with ADHD also are affected by oppositional defiant disorder (ODD) (APA, 2000). According to criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), ADHD is subdivided into three types: predominantly inattentive, predominantly hyperactive/impulsive, and the combined type (which includes symptoms of both inattention and hyperactivity/impulsivity). The combined type is the most prevalent, and it presents greater impairment to overall functioning than do the other two types ( American Psychiatric Association, 2000 and Rohde and Halpern, 2004). To date, numerous investigations have described the neurobiological bases of ADHD. Morphometric and neuroimaging studies have identified the brain regions with abnormalities in individuals with this disorder. The main changes found in children are reductions in volume of the prefrontal cortex, the caudate nucleus, the globus pallidus, the anterior cingulate, and the cerebellum, mainly in the vermis and inferior posterior lobe (Berquin et al., 1998 and Valera et al., 2007). Shaw et al. (2007) characterized a delay in the cortical maturation of patients with ADHD by comparing 223 children and adolescents with the disorder, and 223 typically developing children (control group). The aim of this study was to define the trajectory of cortical development using a measure of cortical thickness. The delay was most prominent in the prefrontal regions important to the control of cognitive processes, including attention and motor planning. Children with ADHD not only display hyperactive motor behavior, but half of them, also, are clumsy when executing motor skills (Pitcher, Piek, & Hay, 2003). Motor problems can have a severe impact on children's daily lives, and occur in 30–50% of children with ADHD (Fliers et al., 2009 and Visser, 2003). Unrest, marked by a continuous exchange of activities, can lead to problems with academic performance, and in difficulties with social relations. For example, excessive activities such as unnecessary body movements, impulsivity, anticipating responses, and the inability to wait for particular events can cause learning disabilities and motor disorders, which may result in school failure (Goulardins, 2010 and Toniolo et al., 2009). The aim of the current study, therefore, was to assess the motor profile of children with ADHD, combined type.