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- 1. Éñ½›¾«ÉñátŒWµÚ39 ¾íµÚ3 Ì–2000 J Korean Neuropsychiatr Assoc Vol 39, No 3 ¿Ú? ?¿Ú ?? ??? ????? ?????? ??? ???? ??* ? ? ?**t . ? ? ?** The Comparison of the Executive Functions in Children with Tourette's Disorder with Those with Attention Deficit Hyperactivity Disorder* Hyung-Mo Sung, M.D., **t Hyung-Bae Park, M.D. ** ????: ????(??TS)? ???????????(?? ADHD)? ????? ???? ?? ???? ? ????? ?????? ??? ????? ??? ??? ? ??? ?????. ?? ? ?? : DSM-N ? ????? ??? TS?? ???? 18?? ??? ADHD?? ???? ?? 18?? ????? ??????£¬ ??? 18?? ???? ??? ??? ??£¬ ?? ?? ???? ???? ? ? ??? ?? ??? ? DSM-IV?? ?? ????? ?? ??? ?????? ?????. ? ??? ?????? ?? ?? ????? ?? K-ABC??? ??????£¬ ????? ??? ?? ? ???? ???? ??(?? WCST) ? ??????(CPT)? ?????£¬ ?? ??? ???? ? ???? ??? ??? ???? ?? ?????. ? ?: ? ???? CPT ?? ?????£¬ ???¡¢ ?????? ADHD?? ???? ?? (p<O.05) ? ? ?? ??¡® TS?? ???? ??? ???. ???????? ADHD?? TS?? ???? ?? ?? ? ??? ?? (p<O.05) £¬ ADHD? TS? ?? ?? ??? ??? ?? ? ? ???. WCST ????? ????. ????£¬ ???????. ??? ????? ? ??? ?? ???? ?? ???? ??? ??? ???? (p<O.05) £¬ ?????. ???????? ADHD??? ??? ? ?? ??? ??? ??? (p<O.05). ? ?: TS? ADHD ? ??? ?? ????? ??? ????. TS? ?? ADHD?? ?? ??? ?? ???? : 2000? 1 ? 18? ???? : 2000? 4? 14? *? ??? ??? 1999? 10? ????????? ??????? ?????? ???? ???????? ????? ???? ?????? Department of Psychiarry, College of Medicine, Yeungnam Universi¦Ç" Taegu ¡¯Corresponding author - 610 -
- 2. ??? ??? ????? ? ? ?? ???. ?? ??? ?????? ??? ? ????? ?? ? ? ????? ???? ??? ???? ??? ? ? ?? ???. ?? ?? : ?? ?? ¡¤ ????? ?????? ¡¤ ???? ¡¤ ?????? ¡¤ ???? ??????. ? ? ¡®- ???? (executive function) ?? ??? ??? ? ??? ??? ?????? ??? ??? ??? ??? ???? ?? (planning) . ??? ?? (decis?ion making). ???? (self-directed go? selection) . ??? ???? ?? ??? ???? ??? ?? (monitoring and altering ongoing behavior to achieve goal) ?? ??? ??? ???? 1l2) ?? ????? ?? ??? (frontal lobe) ? ???-?? ? ????? (frontal-subcortical circuit) ? ??? ?? ??? ??? ?? 2-4) ????? ???? ??? ????? ??? ?? ??? ???-??? ?????? ?????? ? ? ???? ?? ??? ??? ??? ? ? ??. ? ?? ???? ? ??? ???? TS? ?? ?? ????? ???? .ADHD. ???? ? ??? ? ??? ??? ???? 13- 16) ADHD? ???? TS ??? 50-60% ?? ???? 15) 7) ??????? ? ??? ??? ???? ?? ????? ????? ? ??.? ??? ?? ??? ??? ?? ? ??? ?? ??? ? ???? ?? ??? ??? ??? ????. ? ??? ?? ????? ??? ?? ??? ?? ???£¬ ? ??? ?? ??? ??? ???? ?? ? ??? ??? ????. ?? ???? ? ?? ? ?? ???? ?? ???? ???? ?? ¡¤ ??? ??? ?? ????? ?????? (Attention defi- ¡¯ ??? ?? ?? ????. ??? ???? TS? ? ci¦Íhyperactivity disorder. ?? ADHD? ??)? ? ? ??? ADHD? ?? ????? ????? ?? ??? ??? ??? ??????? PET ?? ?? ?? ??? ???? ??? ????? ?? ???. ? ?? ???? ADHD? ???? ????? ?? ?? ?? ?????? 5) ???-??? ????? ? ????? ??? ????? ??? ? ??? ? ?? ??? ???? ?? ??? ??? ?? 2) ?? ?? ? ??? ???? ??? ???? ??? ?? ?? ??? .ADHD? ????? ????? ??? ?? ??? ????.? ?? ? ??? ?? ? ?? ?? ???? ?? ??????? ???? ??? ? ???? ??. ?? ? ??? ??? ???? (Tourette¡¯s disorder. ?? TS? ??)? ??? ? ?? ?????? ?? ?????? ???? ?? ?? ???? ???. ??????? ??? (basal ganglia). ?? ? ??(thalamus) ?? ? ???? ??? ??9- 12) ???? ???? ADHD? ??? ? ???-??? ?????? ??? ?? ?? ?? ? ?????? ??? ????? ??¡¯ ?. AD?HD? TS ?? ??????? ???? ??? ?? ??? ???? ???? ?? ??? ???£¬ ??? ?? ????? ??? ? ??? ????? ??? ???????. ?? ??? ????? ??? ?? ??? ??? ?? ??? ??? TS? ADHD ????? ??? ?? ????£¬ ?? ???? ??? ? ???? ? ? ???? ? ???? ???? ??? ?? ? ? ?? ????? ? ??? ?????. ?? ? ?? 1. ?? ?? 1999? 3? 1 ??? 9? 31 ??? ????? ?? ?? ???? ??????? ??? ??? ??? ? ???? ?? ????? ?? ? ????. ? 4 ?(Diagnostic and Statistical Manual of Mental Disorder. 4th edition. ?? DSM-IV? ??) 19)20)? ????? ???? ??? ??? ? ???? ?? TS? ADHD? ??? ??? ? ??. ??? ??? - 611 -
- 3. Table 1. The comparisons of age an? IQ for children with Tourette¡¯5 disorder, AOHO, and control groups Variables TS(N=18) ADHO(N=18) .. Control(N=18) P-value Mean :l: SO , Age(year? 8.78:1: 1.11 8.50:1: 1.1 0 9.00:1: 0.91 0.38 IQ* 104.66:1: 11.98 100.72:1: 11.69 114.6l:t10.60 0.00 AOHD : attention deficit hyperactivi¦Ç disorder, TS : Toure?e¡¯ 5 disorder, N : number of subjects, SO : standard deviation IQ : measured by K-ABC ?. : The TO and ADHO group are significantly lower than the normal group(p<0.05, post hoc Bonferroni testl ? TS ?? 18? . ADHD ?? 18?? ?????? , ?? ??? ??? ???? ?? ?? ??? ?? 18?? ????? ?????. ?? ??? ???? ? ? 7-12? ??? ?????? ??????£¬ ? ? ???? ????? ??? ???? ?? ??? ????? ??? ??? ????? ?? ??? ? ????? ?????. 2. ?? ?? ????? ?? ????? ??? ??? ??? K-ABC(Kaufman Assessment Battery for Chil?dren, ?? K-ABC? ??)??? ? ????2Il ?? ??? ??? ??????(Continuous Perform¨¦??ce Test, ?? CPT? ??)?)? ???? ???? ? ?(Wisconsin Card Sorting Test. ?? WCST? ? ?)23)? ???? ????? ?? ??? ????? ?? ??? ???? ??? ?t??? ?? ???? ?. ??? ???? ???? ?????? ?? ?? ???. ? ???? ????? ??? ??? ??? K?ABC? 1997? ???? ???? ???? ????? ??????. ?? ??? ?DI-W1SC? ?? IQ? ? ??? 0.74?? ?? ???? ??? ??? 21) ????? ??? ??? CPT? Conners? ?? ??. Multi-Health Sys~m Inc. ?? ??? CPT ????? ?????. ? ????? 117U ? ??? ?? ???? (hit) , ???? Comission error) , ?? ???(commission error), ? ??? ?(hit reaction time). ? ????? ????(hit reaction time st?andarde¦Ðor)£¬ ????? ??? (variability of st?andard e¦Ð'or) , ??? ???(attentiveness¡® d¡¯)? ????(risk taking, ~)? ??????£¬ ???? ? ?? ???? ?? ? ???????. WCST ?? ???? ????? ??????£¬ ? ???(number of trials adminlstrated). ? ??? (total number of correct). ???? (total number of e¦Ðors) , ????? (perseverative response). ? ????(perseverative error) , 1:1 1????? (nonper?severative errors) , ???????(con?ptual level response) , ??? ??? (number of categories co?mplete) , ????????(trials to complete first category). ?????(f:?lure to maintain) , ??? ? Oe?ning to leam) ? ? 11?? ????? ?? ????£¬ ????? ?? ???? ?? ? ?? ? ????. CPI¡®? WCST? ????? ??? ???? ??? ???? ???? ?? ???? ???1)24)25) CPT? ?? ?? ?????? ?????£¬ ??? ???? ???? ??£¬?£¬) WCST? ??? ??. ??(categori?za?on) £¬ ???? (wor?ng memory), ??? (flexibili?ty) ?? ?? ? ? ??.?)2'1) 3. ???? ??? ???? ??? ???? (Analysis of Vari?ance; ??¡£'VA)? ?? ??? ??? ????£¬ ?? ??? ??? Bonfe¦ÐonJ ???? ????? ?? ? ???? ??? ?? IQ? ???? .?? IQ? ? ???? ?? ????? (Analysis of co-variance ; ?JCOVA)? ????£¬ ?? Bonferroni ???? ? ?????. ?? ?????? ??? ????? ?? 0.05 ???? ???. ? ? ? ??? ????? TS?? 8.78:tl.l 1???. A?DHD?? 8.50:t1.l0?£¬ ???? 9.00 :t O.91 ?? ? ???? ?????? ??? ??? ???. ???? ??? ?? TS?? ?? 104.66:!:11.98. ADHD?? - 612 -
- 4. Table 2. The comparison of the results on continuous performance test for children with Tourette¡¯s.disorder, ADHD and control groups Variables T5(N=18) ADHD(N=18) Control(N = 18) F-value P-value Mean :t5D HIT 249.89:t 49.37 263.78:t 27.18 279.05:t 23.87 3.06 0.05 OMI 74.11 :t 49.37 60.39:t 27.26 44.94:t 23.87 3.07 0.06 COM' 18.28:t 8.36 24.56:t 2.72 18.22:t 5.64 6.56 0.00 HIRT 418.59:t 69.56 417.31:t 37.69 357.00:t 50.28 2.54 0.09 RT5E 20.73:t 15.50 18.13:t 10.26 12.1 2:t 10.88 2.27 0. 11. V5E 52.66:t 40.64 43.22:t 27.35 26.96:t 33.78 2.58 0.09 DDb?c 0.81 :t 0.56 0.44:t 0.27 1.16:t0.74 7.56 0.00 RITAb 0.86:t0.40 0.74:t 0.16 0.59:t0.33 3.27 0.04 ADHD : attention deficit hyperactivity disorder, T5 : Tourette¡¯5 disorder, HIT: hit, OMI :.omission error, COM : com?mission error, HIRT : hit reaction time, RT5E : hit reaction time standard error, V5E : variability of standard error, DD : at?tentiveness, RIT A : risk taking, N : number of subjects, 5D : standard deviation a : The ADHD group perform? significantly worse than the T5 and normal group b : The ADHD group performed significantly worse than the normal group c : The TS group performed significantly worse than the normal group a,b,c : p<0.05, post hoc Bonferroni test Table 3. The comparison of the res?ts on Wisconsin card sorting. test for children with Tourette¡¯5 disorder, ADHD. and control groups Variables T5(N=18) ADHD(N=18) Control(N = 18) F-value P-value Mean:t5D TA' 124.78:t 6.98 128.00:t 0.00 115.78:t 17.13 6.33 0.00 TC 66.83:t 16.86 61.72:t 19.98 75.28:t 23.41 2.05 0.14 TE' 57.94:t 20.85 66.27:t 19.97 35.94:t 18.46 11.29 0.00 PRb 36.28:t 21.50 45.17:t 30.64 20.83 :t 9.77 5.47 0.01 PEb 30.83:t 16.49 38.06:t 22.52 18.61:t 8.01 6.19 0.00 NONP 27.1 1:t 14.70 28.22:t 17.09 17.33:t 12.21 2.95 0.06 CLR' 49.83:t 22.97 43.17:t 24.58 70.33:t 16.33 7.74 0.00 CC' 3.00:t 2.00 2.00:t 1.19 4.56:t 1.62 11.16 0.00 TC1 20.44:t 15.00 35.00:t 37.33 19.89:t 16.86 2.08 0.14 FM5 1.55:t 1.58 1.44:t 1.50 2.1 2:t 1.23 1.1 5 0.33 LL 9.75:t 13.87 - 8.98:t 14.25 ~ 0.79:t 1.91 3.34 0.06 ADHD : attention deficit hyperactivity disorder, T5 : Tourettefs disorder, TA: number.of trials. administrated; TC : total number: of correct, TE ¡¯ total number of errors, PR: perseverative response, PR: perse¡®verative error, NONP: non?perseverative errors, CLR : conceptual level response, CC : number of categories complete, TC1 : trials to complete first category, FM5 : failure to maintain, LL : learning to learn, N : nurnber of subjects, 5D : standard deviation a : The ADHD and T5 groups performed significantly worse than the normal group b : The ADHD group performed significantly worse than the normal group a,b : p<O.05, post hoc Bonferroni test 100.72 :t l 1. 69???. ???? ?? 114.61:t 10.60? ? ???? ? ???? ?? ???? ????. ? ??? ???? ??? ??? ???(p<O.05)(? 1). ? ??? CPT ????? ?????£¬ ???. ? ????? ? ???? ??? ??? ?? ??? ? ???? (p<0.05). Bonferroni ???? ?? ? ? ?? ?????? ADHD?? ???? ?? ??? ??? ??? ??? ??? ??? (p<O.05). TS? ? ?? ????? ???? ??? ??? ???? (p<O.05) ¡® ?? ??? ?? ?????? ???? ???? ??? ??? ???. ?? ?????? ? ??? ADHD?? TS? ???? ??? ??? ? ? (p<0.05). ADHD?? TS?? ?? ? ?? ?? ? ?? ??? ????. ?? ???? ????? - 613 -
- 5. Table 4. The comparison of the results on continuous performance te? for children with Tourette's disorder, AOHO and normal groups after adjustment for IQ' Variables T5(N=18) AO? 0(N=18) Control(N = 18) F-value P-value Mean :l:50 HJT 249.89:1: 49¡®37 263.78:1: 27.18 279.05:t 23.87 2.68 0.08 OMI 74.11 :1:49.37 60.39:1: 27.26 44.94:1: 23.87 2.68 0.08 COM' 18.28:1: 8.36 24.56:1:2.72 18.22:1: 5.64 4.49 0.02 HIRT 418.59:1: 69.56 417.31 :1: 37.69 357.00:1: 50.28 0.89 0.42 RT5E 20.73:t 15.50 18.13:1: 10.26 12.12:1: 10.88 1.1 2 0.34 V5E 52.66:1: 40.64 43.22:t 27.35 26.96:t 33.78 1.41 0.25 00" 0.81:t0.56 0.44:1:0.27 1.16:1:0.74 3.91 0.02 RJTA 0.86:1: 0.40 0.74:1: 0.16 0.59:1: 0.33 2.45 0.09 AOHO : attention defrcit hyperactivi¦Ç disorder, T5 : Tourette¡¯5 disorder, HIT : hit, OMI : omission error, COM : com?mission error, HIRT : hit reaction time, RT5E : hit reaction time standard error, V5E : variability of standard error, 00 : at?tentiveness, RITA : risk taking, N : number of subjects, 50 : standard deviation a : evaluated at covariates appeared in the model : IQ=106.67 ? : The AOHO group differ signifjcantly from the T5 group after adjustment for IQ ?? : The AOHO group differ signilicantly from normal group after adjustment for IQ .,.. : p <0.05, post hoc Bonferroni test Table 5. The comparison of the res ? ts on Wisconsin card 5¡£¦Ðing test for children with Tourette¡¯s disorder, AOHO and normal groups after adjustment for IQa Variables TS(N=18) AOHO(N=18) Control(N = 18) F-value P-value Mean:l:50 TA* 124.78:1: 6.98 128:00:1: 0.00 115.78:1: 17.13 3.41 0.04 TC 66.83:t 16.86 6 1.72ÍÁ19.98 75.28 :1: 23.41 0.69 0.50 TE" 57.94:1: 20.85 66.27 :1: 19.97 35.94:1: 18.46 6.06 0.00 PR" 36.28:1: 21 .50 45.17:t 30.64 20.83:::9 .77 3.17 0.05 PE" 30.83:t 16.49 38.06:1:22.52 18.61:t8.01 3.66 0.03 NONP 27.1 1:t 14.70 28.22:!:: 17.09 17.33:::12.21 1.27 0.29 CLR" 49.83:1: 22.97 43.17:::24.58 70.33 :1: 16.33 4.08 0.23 CC" 3.00:1: 2.00 2.00:1: 1.19 4.56 :1: 1.62 6.00 0.00 TCl 20.44:1: 15.00 35.00:1: 37 .33 19.89::: 16.86 1.23 0.27 FM5 1.55::: 1.58 1.44:1: 1.50 2.12 :1: 1¡®23 1.06 0.35 LL - 9.75:1: 13.87 - 8.98:1: 14.25 - 0.79:1: 1.91 1.74 0.18 AOHO : attention deficit hyperactivity disorder, TS : Tourette¡¯5 disorder, TA : number of trials administrated, TC : total number of correct, TE: total number 01 errors, PR: perseverative response, PR: perseverative error, NONP: non?perseverative errors, CLR : conceptual level response, CC : number of categories complete, TCl : trials to complete fi¦Ðt category, FMS : failure to maintain, LL : learning to learn, N : number of subjects, SO : standard deviation a : evaluated at covariates appeared in the model; IQ= 1 06.67 ? : The AOHO group differs significantly from normal group after adjustment for IQ ?? : The AOHO and the T5 groups differ significantly from normal group after adjustment fm IQ .,.. : p<0.05, post hoc Bonlerroni test ???? ? ?? ??? ??? ??? ????£¬ AD?HD?? ?? ??? ??? ?? ??? ?? ??? ????(? 2). WCST ????? ????. ???? ????? ??¡® ??? ???£¬ ?????? ?????? ? 6?? ?? ???? ?l ??? ??? ??? ?? ? ?? ????? (p<O.05). ?? ? ????. ??? ?. ???????£¬ ??? ????? ADHD. TS ? ??? ?? ????? ???? ??? ??? ? ? ?? (p<O.05). ?????? ???????? AD?HD???? ???? ?? ??? ??? ??? ??? ???? (p<O.05) (? 3) - 614 -
- 6. IQ? ??? ? CPT? ????? ??? ???? ? ??????? ADHD?? TS?? ?? ???? ?? ???? ???? (p<O.05). ?????? AD?HD??? ???? ?? ??? ??? ?? ??? ???? (p<O.05). ??????? ? ??? ??? ?? ??? ????(? 4). IQ? ??? ?? WCST ????? ??. ??? ???? ? ????? ?? ???? ?? ??? ? ?? ?????? (p<O.05). ????. ?????. ?????. ???????. ??? ???? 5? ? ?????? ADHD??? ???? ?? ???? ??? ??? ???? (p<O.05). TS?? ??? ? ?? ??? ??? ?? ??? ????(? 5). ? ? TS? ADHD? ?? ????? ??? ??? ?? ??? ??????£¬ ??? ?? ??? ?? ?? ? ???. ??. ???? ????? TS? ?? ??? ?? ??? ??? ?? ????. ? ??? ?? ? ?? ??? ????. ??? ???? ??? ?? ? ???? ADHD? ?? ????? ????? ?? ???? WCST. Stopping test. Maze test. Word fluency test ? ????? ???? ?? ???? ? ??? ??? ??? ???£¬ ??? ????? ?? ? ?? ??? ????. TS? ???? ??? ?? ?? ?? ?? ? Category test. VerbaI fluency test. Trail making B ?? ???? ?????? ??? ??? 11 ?? TS? ADHD? ??? ??? ?? ???? ? ? ????? ????. ????. ??????. ?????? ???? TS? ?? ???? ADHD? ??? ??? ?? ? ?? ??? ????? 151?¡û30 ?? ?????? ??? ? ??? ??? ?? ?? ??? ??? ?? ????? ??? ??? ??? ???? ??? ??? ?? ???.? 16' CPT? ??? ? ?? ???? ???? ADHD ??? ?? ???? ?? ??????. ????? ? ??? ??? ???? ??? ???. ??? ? ???? ???? 26 1 31¡® ?J)HD ???? ?? CPT? ??? ????? ????? (commission error)? ???? (omission elTor)7r ?? ??? ????? ? 3213.3) ? ? ??? ???? ???? ?? ??? ? ??? ???? ?? ??£¬? 1351 ???? ????? ??? ???? ?????? ??? ???? ?? ??? ?????? .CP1¡®? ??? ? ????? ADHD ??? ?????? ?? ?????. ??? ?? ?? ????. ?????? ????? ??? ?? ??. ???? ??. ?? ??? ?? ??? ? ???? 261 ?? ????? ????? ?????. ?????? ????. ??? ??? ?????? ??? ??? ????? 36' ? ????? CPT? ? ???? ADHD ??? ?? ?????. ???. ? ????? ??? ??? ?? ??? ?? ???? ?????. TS? ?? ??? ?? CPT? ??? ? ?? TOVA(Test of variability of attention)? ? ?? ?? ????? TS? ?? ???? ???? ??? ??? ???? ?????.?W ? ???? ? TS ???? ?????? ???? ?? ???? ?? ??? ?? ??? ???? ??? ??? ?? ???. ??? ???? ???? TS? ???? ? ?? ????? ?? ??? ???? ??? ?? ? ? ????. ? ??? ??? ? ?? ???. WCST? ????? ?????? ??????? ADHD???? ???? ??? ??? ???? . ? ? IQ? ??? ? ????. ?????. ?????. ???????. ??? ????? ADHD?? ?? ? ??? ???. WCST ??? ??? ? ?? ?? ?? ?? ADHD ???? ???? ? ?? ?? ? ??? ?? ?? ???? ?? ????? ???? ??? ??? :~:I?l ?? ??? ???? ??? ?? ?? ??? 39' ???? ?????? ADHD ??? ? WCST? ????? ??? ?? ??? ???? ?? 11 ? ????? ?? ????? TS? ?? ??? TS? ADHD? ?? ?? ??? ? ??? ?? ???? ??? TS ?? ??? AD?HD?? ???? ?? ? ?? ????? ???? ??? ?? .30 TS? ADHD?'ADHD? ???? ? ? ?? ????? ????? ???? ??? ?? ? ? ??? ???? ??? ¡± ??? IQ? ??? ? ??? ???? ?? ???? TS?? TS? AD?HD? ??? ? .ADHD?? ???? TOVA. WC- - 615 -
- 7. 81¡¯. Rey-osterrieth complex figure test ?? ?? ? ??? ??? ??? ?? ? ??? ??? ?? ???? ????? ??? ?????.ADHD?? ADHD? TS? ??? ??? TS ?? ?? ? ?? ????? ??? ??? ??? ?????¡® non?verbal planning. self-monitoring ?? ??? TS? ?? ADHD? ?? ???? ?????. ??? ? ?? ?? ??? ??? ??? ??? ?? ??? ??? ? ??? ?? ? ?? ??? ???? ?? ???? 29) ??? ???? ??? ???? ??? ??? ? ?? ?? ?? ???? ???? ??? ??? ? ?? ???? ?? ?????£¬??) ??? ???? ADHD ???? ?? ????? ??? ??? ?? ? ???? ???? ??? ??? ??? ????. ??? ? ????? CPT ????? WC8T ??? ? ADHD? TS ?? ????? ??? ??? ?? ? ? ??? ?? ???? ?????? ??? ?? ?????? ???? ??? ??? ?? ???? ???}? ??? ?? ???.?) ?? TS? ADHD? ?? ????? ??? ????£¬ ??? ??? AD?HD?? ? ?? ?? ???? ??? ???? ?? ? ?? ???? ???? ? ???? ??? ??? ?? ? ???? ?????? ??? ?? ? ?? ??(confounding bias)'{) IQ? ??? ? ? ??? ? ??? ??? ??? ? ??. ADHD? ???? ??? TS?? ?? ??? ???? ?? ? ? ?? ?. ? ??? ???? ??? ?????? ??? ??? ? ??? ?????? ??? TS ???? ??? ????? ??? ?? ????? ??? ? ?? ???? ??? ? ?? 18129) ? ??? ?????? ?????? ?? ??? ?? ??? ?? ??? ? ??? ??? ???? ?? ?? ? ? ???¡® ?£¬AJ-???? ????? ? ?? ???? ?? ???? ?? ??? ???? ? ??. ?£¬ ???? ?????? ??? ?? ? ?? ? ????? ?? ???? ?????? ??? ? ? ??? ?????? ???. ? ??? ??? ??? ???? ??? ??? ? ?? ???? ??? ?????£¬ ????? ??? ? ?? ????? ?????? ??? ?? ??? ??????£¬ ???? ADHD? ?? ??? ??? ? TS ?? ?? ???? ?????? ? ??? ? ???? ?? ?????. ? ?? ???? ??? ??? ???? ? ??? ???? ????. ? ? ?? ?? ???-??? ?????(front?-subcor?tical circuit) ? ????? ADHD? ?? ???? ? ???? ???? ??(dorsolateral circuitl ? ? ?? WC8T?? ???? ??? ??? ???. TS ? ????-??? ?????(orbitofron?l-subcor?tical circuit)? ??? ?? ????? ??? AD?HD?? ??? ??? ???? ??? ? ? ?? ? ??.? ??? ?? ??? ??? ?? ???? ?? ????? ? ???. ADHD? TS? ???? ?? ? ???? ?? ??? ???? ADHD? ???? ??? ?? ??? ??? ??? ??? ?? ?? ? ? ?? ???. ??? ???? ??? ?? ?? ? ????? ???? ?? ?? ?????? ?? ? ????? ?????? ?? ??? ? ? ?? ?? ???? ??? ????£¬ ??? ???? ?? ? ? ?? ?????? ???? ? ??? ???? ????? ??? ?? ??? ??? ?? ???? ???? ???? ? ??? ??? ? ??? ?? ????? ????? ??? ??? ? ???. ?? ??? ??? ??? ?? ??? ???? ??? ? ??? ? ???? ????. ????? ??? ?? ? ??? ???? ???? ?? ?? ?? ??? ????? ??? ? ???. ???? 1) Pennington BF, Ozonoff 5(1996) : Executive runc?tion and developmental psychopathology. J C?ld Psychol Psychiatry 37(1) : 51 -87 2) Miller BL, Cummings JL(1999) : The human fron?tal lobe : functions and disorders, New York, The Guilford Press 3) Welsh MC, Pennington BF(1988) : Assessing fron?tal lobe functioning in children : Views from de?velopmental psychology. Developmental Neurops?ychology 4 : 199?30 4) Denkla MB(1989) : Executive function, the overlap zone between atlention deficit hyperacti?ty disor- - 616 -
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- 10. ABSTRACT J Korean Neuropsych?¦Ð Assoc Vol 39, No 3, May, 2000 The Comparison of the Executive Functions in Children with Tourette¡¯s Disorder with Those with Attention Deficit Hyperactivity Disorder Hyung-Mo Sung, M.D., Hyung-Bae Park, M.D. Department o[ Psychia¦Ç College o[ Medicine, Yeungnam University, Taegu Objectives : This study w;? perfonned to veriJY and compare deterioration of executive ?lctiOns in ?e children ?th Tourette¡¯s disorder(TS) with thos¦Å ¡®?th Attention D?cit Hyperactivity Disorder(ADHD) and to understand the differentes. Method : We administered Kaufinan Assessm¦Ånt Batte¦Ð for Childr¦Ån(K-ABC) £¬ Continuous Performance Test(CPT), W¨¬sconsin Card Sorting Test(WCST) on thr¦Å£¬ e groups, of 18 children each : tow groups of outpatients, one pure TS and one pure ADHD, diagnosed using DSM-IV criteria, and the third, a control group of normal, healthy children who were s¦Ålected consider?ing age, sex and academic a'chieverrient. The children perfonned all testings without the use of medications ResuIts : In¨¨omparisons of CPT p¨¦rfotmance, ?e ADHD group show¦Åd poor performance with signif¨¬cant di?rence in commission error, attentiv¦Åness and risk taking(p <0.05), and the TS group showed sig?f¨¬cant difference in attentiveness(p<0.05) when compared ?? ?e control group. There was signif¨¬cant difference between ?e AD HD group and the TS group in commission error(p <0.05). In comparisons of WCST, the ADHD group and the TS group showed signif¨¬cantly poorer perfonnance than the controls in number of trials administered, total number of errors, conceptual 1¦Åv¦Å1 r¦Å£¬ sponse£¬ number of categories complete, perseverativ¦Å£¬ response and persevera?tive error(p<0.05), but only ? ADHD group showed poor perfonnance in pe?verative r¦Åsponse and pe¦Ð¦Åvera?ve e¦Ðor(p <0.05). When the results of CPT were analyzed after adjustrnent for IQ, the ADHD group show¦Å£¬ d signif¨¬cantly more errors than the TS disorder group in commission ¦Årror£¬ and only th¦Å ADHD group showed signif¨¬cant differenc¦Æ in att¦Ån?reness compared ?th ?¦Æ normal controls(p <0. 05). In WCST, while these two groups showed signif¨¬cant differ¦Ånce in numberof trials administrated, only the ADHD group show¦Åd signif¨¬cantly poor perfonnance compared with the normal children group in the 5 sub-cat¦Ågories such as total numb¦Ær of errors, persev¦Åra?ve response, p¦Årseverative. error, conceptual level r'¦Åsponse and number of categori¦Ås complete(p <0.05). ConcIusion : The abnormaliti¦Ås of executive functions appear in both ADHD and Tourette¡¯s disorder, but more appar¦Å£¬ nt abnormaliti¦Åsm ¦Åx¦Åcutiv¦Å functions were shown in ADHD than in Tour¦Å£¬ tte ¡¯ s disorder. A1so the differenc¦Ås of ex¦Åcutive functions suggest ?at these two diseas¦Ås may have different psychopathophysiology in th¦Ås¦Å dimensions. KEY WORDS : Tourette¡¯s disord - 619 -