OACI 10.1 Función
13.6 Datos de aeródromo/helipuerto .1 En este plano se indicarán:
A strength of our study is that young persons may be more suitable for neuropsychological studies than adults because they are less influenced by environmental factors and illness- related sequel, for example such as medication effects and drug abuse is, in parallel to a hypothesized stronger proportional influence of genes 327. Other strengths are that very few of our participants were on mood-stabilizers, we accounted for state, estimated IQ, comorbidity and multiple comparisons, and clinical groups were directly compared with each other and with controls. The main examiner was a very experienced specialist in both neuropsychology and child and adolescent psychology and the assessment procedures were also standardized with regard to time of the day, order and breaks.
Performance in neuropsychological tests may also be influenced by motivation, stress, tiredness, mood symptoms and comorbidities. High anxiety levels may result in mental efficiency problems such as slowing, scrambled or blocked thoughts and words, memory failure and enhanced distractibility, though these are not consistent findings 328, 329. Depression is reported to interfere with memory and response tempo, though cognitive performance by most depressed patients is not affected 329-331. Though we did not reveal any effect of mood symptoms, medication or comorbidity, our sample was too small to rule out effects of these.
Test results are reported for groups, though intra-group variation was considerable on all measures in all groups, limiting the generalization of the results. The heterogeneity of the BD
sample probably contributed to this. Clinical heterogeneity was hardly the case in our well- characterized sample of youths with ADHD-C. However, neuropsychological heterogeneity is a well known theme in the ADHD literature, and may be due to a complex causal structure, as well as intra-individual differences in performance due to poor/ shifting adjustment in different contexts rather than primary neuropsychological deficits 311, 332.
The neuropsychological data were mostly nominal and non-parametrically distributed, and were influenced by several moderators and covariates. Together with our small sample this makes statistic modelling imperfect, which is a common problem in most neuropsychological studies. Also, neuropsychological studies on ADHD-C and BD are difficult to compare due to methodological differences regarding neuropsychological tasks and diagnostic groups as well as failure to account for IQ, state, comorbidity, medication and multiple comparisons.
77
5 Conclusions:
Neither neuropsychological tests nor parent and teacher rated ADHD- symptom
questionnaires differentiate ADHD from BD. Neuromotor tests does. Inattentive symptoms in BD are not related to the inattentive type of ADHD. Cognitive deficits in BD characterize mainly those with a history of psychotic symptoms. Processing speed characterize all BD subgroups and also ADHD-C. Some executive problems are speed-dependent.
These findings may have important implications for everyday diagnostic work and perhaps facilitate interventions in order to prevent functional impairments. The findings may also lend insight into the neurobiological systems that are disrupted in these disorders.
Further studies are warranted to
Clarify whether there are more specific tests that would uncover neuromotor problems in all patients with ADHD-C.
Evaluate whether early intervention may prevent psychosocial, psychiatric and somatic complications of neuromotor problems.
Evaluate whether adapted educational strategies could limit the educational and functional outcome in children with cognitive problems.
Clarify if cognitive deficit is a marker for a serious subtype of BD or an effect of psychotic episodes.
Clarify the interplay between semantic organization and cognitive deficits, psychotic symptoms and behavioral characteristics in BD.
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