Komorbidität von hyperkinetischer Störung und Legasthenie am Beispiel phonologischer, semantischer und syntaktischer Sprachfähigkeiten bei Kindern

Zusammenfassung

Studienziel war es, die Grundlagen der Komorbidität der hyperkinetischen Störung und der umschriebenen Lese-Rechtschreib-Schwäche weiter aufzuklären und zu überprüfen, ob sich die komorbide Gruppe durch additive sprachliche Defizite beider Störungen auszeichnet oder ob sie spezielle Merkmale zeigt, die sie von beiden Störungsbildern unterscheidet. Dazu wurden insgesamt 36 Patienten der Poliklinik für Kinder- und Jugendpsychiatrie/Psychotherapie der Universität Göttingen mit den ICD-10-Diagnosen Legasthenie (LRS) und/oder hyperkinetischer Störung (HKS) im Alter zwischen 9 und 13 Jahren sowie eine Kontrollgruppe nach Alter, Geschlecht und Intelligenz vergleichbarer gesunder Schüler (n = 12) psychopathologisch untersucht und hinsichtlich des Profils ihrer phonologischen, semantischen und syntaktischen Sprachfähigkeiten mit dem Mottier-Test, dem Kunstwörter-Nachsprech-Test nach Hasselhorn und Körner, den Subtests „Wörter Ergänzen” und „Laute Verbinden” des Psycholinguistischen Entwicklungstests und dem Heidelberger Sprachentwicklungstest verglichen. Die Ergebnisse zeigten, dass Kinder mit LRS signifikante Leistungsdefizite in allen untersuchten Bereichen aufwiesen. Für Kinder mit HKS ließen sich dagegen keine signifikanten Defizite in diesen Bereichen nachweisen. Die phonologischen Verarbeitungsdefizite fielen durchwegs deutlicher für die „reine” LRS-Gruppe als für die komorbide Gruppe (LRS + HKS) aus. Das Befundmuster deutet darauf hin, dass die LRS bei zusätzlich vorliegender Komorbidität mit HKS hinsichtlich der Art der basalen Funktionsdefizite nicht nur quantitativ, sondern auch qualitativ von der „reinen” LRS systematisch abweicht. Die mögliche Bedeutung exekutiver Funktionsdefizite in diesem Zusammenhang wird diskutiert.

The present study aimed to further enlighten the basis of the comorbidity of attention-deficit hyperactivity disorder (ADHD) and reading and spelling disorder (RSD) and to scrutinize whether the comorbid group is characterized by language deficits due to the two disorders or by additional specific features. A total of 36 out-patients of the Clinic of Child and Adolescent Psychiatry of Goettingen University with the ICD-10 diagnosis of RSD and/or ADHD, aged 9 to 13 years and a control group of healthy children (n = 12) matched for age, gender and intelligence were assessed psychopathologically compared with respect to their phonological, semantic and syntactic language performance. Measures used included the Mottiertest, the Nonword Repetition Test of Hasselhorn and Koerner, the subtest „word completion” and „sound blending” of the Psycholinguistic Development Test and the Heidelberg Language Development Test. The results showed that children with RSD performed significantly poorer in all investigated areas, while children with ADHD had no significant deficits in these measures. The deficits in phonological processing were more significant in the „pure” RSD group than in the comorbid group (RSD + ADHD). The pattern results suggests that in combination with ADHD, RSD differs systematically not only quantitatively but also qualitatively from the „pure” RSD diagnosis with respect to the type of underlying functional deficit. The possible role of executive function deficits is discussed in this context.

Schlüsselwörter

HKS - Legasthenie - Komorbidität - phonologische Sprachverarbeitung - Kunstwörter - Nachsprechtest

Key words

ADHD - hyperkinetic disorder - reading disorder - spelling disorder - comorbidity - phonological processing - non-word repetition

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1 ADHD, d. h. Attention-Deficit Hyperactivity Disorder, wird nach dem amerikanischen Klassifikationsschema DSM-IV [3] eingeordnet und entspricht in seiner vollständigen Symptomatik etwa HKS, die dem Schema der WHO [4] folgt.

2 Die Autoren danken Dr. Wolfgang Woerner für seine Unterstützung, kritischen Kommentare und wertvollen Anregungen.