Povezanost trihotilomanije i poremećaja nedostatka pažnje s hiperaktivnošću u djece i adolescenata [Correlations between Trichotillomania and Attention Deficit/Hyperactivity Disorder in children and adolescents]

The main goal of this research was to analyse and show the prevalence of ADHD and certain subtypes of this disorder in children and adolescents diagnosed with TTM and the elements which show their connection. Methods: There were 117 participants between the ages of 8 and 17 included in the research. We were comparing three groups with the diagnosis of: TTM (N=38), ADHD (N=40) and OCD (N=39). Diagnoses were determined by the criteria of DSM-IV. We used The Coping Strategies Inventory for Children and Adolescents (SUO), Attention Deficit/Hyperactivity Disorder test (ADHDT),Youth Self Report (YSR). Results: By all three groups of participants there is a high prevalence of psychiatric comorbidity. ADHD is the most prevalent comorbid disorder (n=6) by the participants with TTM. The participants with TTM have a higher quotient of ADHD than those with OCD, more signs and symptoms of impulsivity and attention deficit. The children and adolescents with TTM and ADHD have less combined internalizing problems and lower levels of results on scales which measure anxiety, depression and withdrawal in reference to the participants with OCD. The children and adolescents with TTM and ADHD bite thier nails considerably more often than children and adolescents with OCD. Conclusion: The results of examining the connection of TTM and ADHD indicate the validity of set hypothesis and widen cognitions about TTM as a disorder by which together with internalized problems there is a considerable prevalence of externalized problems. Although the results of this study due to limitations, do not have firm predicative value, they considerably contribute to better understanding and planning the treatment of these disorders. For the time being we can only guess the existence of higher risk for the development of TTM in children and adolescents with ADHD, but the obtained results indicate that this problem should be further researched

CONVERSION DISORDER AND PSEUDOSEIZURES "TOGETHER IN LOVE AND EPILEPSY" TWO CASE REPORTS

U širem smislu konverzivni poremećaj je somatiformni poremećaj (DSM - IV., 1996.). Psihogeni ili neepileptički napadaji (pseudokonvulzije) jedan su od 4 podtipa konverzivnog poremećaja. S obzirom na osobitosti razvoja i pojedinih razvojnih faza diferencijalna dijagnostika psihogenih napadaja kod djece i adolescenata često je vrlo zahtjevna. Glavni zadatak je razlikovati konverzivni poremećaj od organskih smetnji. Diferencijalna dijagnostika zahtijeva i razmatranje mogućnosti postojanja obaju poremećaja istodobno. Jedini način da se, ako je potrebno, adekvatno liječi neuropedijatrijski i / ili pedopsihijatrijski poremećaj jest pravilno postavljena dijagnoza, što najčešće zahtijeva dobru suradnju neuropedijatra, pedopsihijatra, psihologa i kvalitetnu dijagnostičku opremu. Prikazana dva slučaja na zanimljiv način međusobno su isprepletena, inducirana i podržavajuća u psihijatrijsko / neurološkom etiopatogenetskom tijeku. Shvaćena su kao miješani pedopsihijatrijski / neuropedijatrijski slučajevi i upućuju na značenje suradnje subspecijalističkih timova i potrebu dobrog poznavanja surađujućih struka, katkad i do "najsitnijih" kliničkih i drugih osobitosti pojedinih sindroma.Conversion disorder is somatoform disorder (DSM – IV, 1996.). Pseudo seizures are one of 4 conversion disorder categories. Considering all the attributes and specific details of emotional development, the differentiation of psychogenic pseudoseizures from epileptic seizures in children and adolescents might be very difficult. It is most important to distinguish conversion from organic symptoms. We also have to consider the possibility of psychological and organic symptoms presenting at the same time. If necessary, the only optimal way to treat children and adolescents with neurological and / or psychiatric disorders, is to have a correct diagnosis, which demands good teamwork of a child psychiatrist, neurologist, psychologist and adequate diagnostic equipment. These two reported cases are matched in a very interesting way, inducing and maintaining each other in psychiatric / neurological etiology and pathogenesis. So, we recognized them as having mixed psychiatric / neurological pathology and these cases demonstrate the importance of team work between subspecialists and the value of the special knowledge of other related areas of expertise and familiarity with tiny details of the syndrome’s phenomenology

Imaju li ortoptičke vježbe utjecaj na djecu i adolescente s poremećajem nedostatka pažnje s hiperaktivnošću i istodobno insuficijencijom konvergencije?

The aim was to determine whether improvement of near point of convergence (NPC) and binocular vision after orthoptic exercises had any impact on children and adolescents diagnosed with attention deficit/hyperactivity disorder (ADHD) and convergence insufficiency (CI). In this clinical trial, 50 children and adolescents aged 6 to 18 years diagnosed with ADHD and CI received orthoptic therapy that included home-based exercises (pencil push-ups and stereograms) and office-based therapy on synoptophore. Binocular vision and NPC were measured before, during and after therapy. Study subjects showed significant improvement (p<0.05) in NPC and binocular vision after orthoptic exercises. We found statistically significant correlation between stereovision improvement (Lang I) and near point of convergence, suggesting that improvement of binocular function is possible in children with ADHD and CI. Our results showed that NPC enhancement improved stereovision in patients with ADHD. Since progress of binocular function has positive effect on near work and diminishes visual symptoms in children and adolescents with ADHD and CI, it might be reasonable to suppose that orthoptic therapy helps these children improve concentration as well. Further studies are needed to determine whether it might have positive impact on attention.Cilj je bio ustanoviti imaju li ortoptičke vježbe koje smanjuju simptome insuficijencije konvergencije (IK) i unaprjeđuju stereovid utjecaj i na djecu koja uz dijagnozu IK imaju i poremećaj pažnje s hiperaktivnošću (attention deficit/hyperactivity disorder, ADHD). Ortoptička terapija je provedena na 50 djece s ADHD-om i istodobno dijagnosticiranom IK. Terapija je uključivala vježbe kod kuće i vježbe u ortoptičkom kabinetu na sinoptoforu. Mjerena je bliza točka konvergencije (BTK) i binokularni vid na stereotestovima i sinoptoforu prije, tijekom i poslije terapije. Ispitanici su pokazali značajno poboljšanje (p<0,05) u BTK i testovima binokularnog vida nakon ortoptičkih vježbi. Pronađena je statistički značajna korelacija između poboljšanja BTK i stereovida (Lang I.), što upućuje na zaključak da je poboljšanje binokularnog vida moguće u djece i adolescenata s IK i ADHD-om. Prema rezultatima našeg istraživanja ortoptička terapija dovodi do poboljšanja BTK i istodobnog poboljšanja binokularnog vida u djece s ADHD-om i IK. Kako unaprjeđenje binokularnog vida ima pozitivan učinak na kvalitetu rada na blizinu i istodobno smanjuje nespecifične vidne simptome koje često imaju djeca s ADHD-om i IK, moguće je da ortoptička terapija može utjecati i na poboljšanje koncentracije, što mislimo da je razumno dalje ispitati. Potrebna su daljnja ispitivanja koja bi utvrdila utječu li ortoptičke vježbe i kako na koncentraciju i pažnju

Holistic approach in the treatment of a boy with Tourette’s disorder

Touretteov poremećaj (TP) neurorazvojni je poremećaj s kombiniranim motoričkim i vokalnim tikovima. Etiologija bolesti nije jasna, ali rezultati istraživanja upućuju na važnost genetičkih faktora. U radu je opisan slučaj holističkog pristupa u liječenju desetogodišnjeg dječaka s Touretteovim poremećajem. Primijenjena farmakoterapija bila je usmjerena na komorbidna stanja, a ne na same tikove. Remisija je uslijedila nakon godinu dana liječenja.Tourette’s disorder is a neurodevelopmental disorder with combined motor and vocal tics. The etiology of the disease is not clear, but results suggest the role of genetic factors. The paper describes a case of a holistic approach in the treatment of a ten-year-old boy with Tourette’s disorder. The pharmacotherapy applied was focused on comorbid conditions, and not on the tics. Remission followed after one year of treatment

CLINICAL CHARACTERISTICS AND COMORBIDITY OF PEDIATRIC TRICHOTILLOMANIA: THE STUDY OF 38 CASES IN CROATIA

Background: The main goal of this study was to analyse and show clinical characteristics and psychiatric comorbidity in 38 participants aged between 10 and 17 with DSM-IV diagnoses of Trichotillomania (TTM) that we were treating at Children\u27s Hospital Zagreb from 2008 to 2017. Subjects and methods: We analyzed the data obtained from semi-structured interviews by the criteria of DSM-IV, Youth Self Report (YSR) (Achenbach & Rescorla 2001) and survey that we created. Results: From 38 participants 21 were girls. The activities during which the participants state that they mostly pull hairs are as follows: doing homework and learning, working on PC, in the toilet, watching TV etc. The most common sites on the body from which participants pulled hair were scalp and among nonscalp sites eyebrows and eyelashes. We found nail biting in more than a half of participants. In 22 participants one or more comorbid disorder has been found, of which ADHD (n=6) and tics (n=5) are most co-occurring disorders. The internalized and externalized problems were nearly evenly represented. Trichophagia was reported by two participants. The results indicate that more than two thirds of participants isolate themselves during hair pulling and half of them try to hide consequences. Median time from the first occurrence of the symptoms to the first visit to a child psychiatrist caused by TTM problem was 9 months (min 5; max 24) what we consider a very long period of time that increased the probability of complications. Conclusions: Knowledge about this disorder and cooperation among pediatric experts is extremely important for recognizing it at an early stage and starting the treatment especially considering habit-forming mechanism, the burden of an emotional distress and frequent comorbidity. Further research is needed

Trichotillomania and comorbidity in adolescents: two case reports

Trihotilomanija je relativno rijedak poremećaj. U Dijagnostičkom i statističkom priručniku mentalnih poremećaja (DSM-V, 2013.) svrstan je u skupinu s opsesivno-kompulzivnim i njemu srodnim poremećajima. Trihilomanija ima i karakteristike poremećaja impulsa i navika. Prvi simptomi trihilomanije najčešće se pojavljuju u adolescenciji. Klinička slika u djece i adolescenata često je komplicirana postojanjem komorbiditeta. Najčešće opisivani komorbiditet su anksioznost i depresija iz područja osjećaja i raspoloženja, a rjeđi su tikovi, hiperkinetski i opsesivno-kompulzivni poremećaj, različiti oblici regresivnog ponašanja i neki drugi. Prikazana su dva bolesnika kod kojih je prepoznavanje poremećaja bilo otežano time što djeca i adolescenti nerado priznaju trihilomaniju, a daljnje liječenje bilo je dijelom multidisciplinarno i u mnogo čemu je ovisilo o komorbiditetu. U prvom prikazu etiopatogeneza je najvećim dijelom emocionalna. U drugom prikazu prateći poremećaj je iz skupine neurorazvojnih poremećaja. Odabir psihoterapijske tehnike i širi pristup liječenju u cijelosti su ovisili o komorbiditetu i zahtjevali su suradnju dječjeg psihijatra sa stručnjacima iz drugih područja pedijatrijske medicine. Mislimo da istraživanja ovog poremećaja treba ustrajno i dalje usmjeravati otkrivanju izravne i druge povezanosti trihilomanije i komorbiditeta, kako bi se omogućilo što primjerenije i učinkovitije prepoznavanje i liječenje ovog poremećaja.Trichotillomania (TTM) is a relatively rare disorder. In recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, 2013), TTM is classifi ed in the group including obsessive-compulsive and related disorders. TTM also has some characteristics of the disorders of impulses and habits. Initially, TTM symptoms usually occur during adolescence. The clinical picture in children and adolescentsis often complicated by the presence of comorbidity. In children and adolescents, the most common comorbidity is in the domain of aff ect, specifi cally depression and anxiety. Rarely described comorbidities are tics, hyperkinetic disorder, obsessive-compulsive disorder, various forms of regressive behavior, and some others. In the two cases reported, recognizing TTM was impeded. Specifi cally, children and adolescentsreluctantly acknowledge TTM, so recognizing and further treatment was in many ways multidisciplinary and depended on the comorbidity. In the fi rst case, the etiopathogenesis is mostly emotional. In the second case, the associated disorder is from the group of neurodevelopmental disorders. The choice of psychotherapeutic techniques and broader approach to the treatment entirely depended on the comorbidity and also required cooperation of experts from other areas of pediatric medicine. We believe that research should persistently be focused on discovering direct and other relationships of TTM and comorbidity in order to allow for the most appropriate and eff ective recognizing and treatment of this disorder

Correlations between attention deficit/hyperactivity disorder, obsessive-compulsive disorder and tics in children and adolescents: case report

Povezanost poremećaja nedostatka pozornosti s hiperaktivnošću (ADHD), opsesivno-kompulzivnog poremećaja (OKP) i tikova primarno se opisuje kroz genetičke, neurobiološke, neurokognitivne i neurokemijske supstrate smanjene inhibicije motoričkog odgovora. Komorbiditet ovih poremećaja u djece i adolescenata nije rijetkost. U predškolskoj dobi u našeg 14-godišnjeg pacijenta dijagnosticirani su ADHD i tikovi, a potom u desetoj godini i OKP. Poremećaji su dijagnosticirani prema kriterijima iz DSM-IV. i uporabom polustrukturiranih intervjua koji se na njemu temelje. U multimodalnom pristupu liječenju provodili smo kognitivno-bihevioralne psihoterapijske tehnike, psihoedukaciju i potporu roditelja, terapiju senzorne integracije uz potporu terapijskog psa, neurofeedback te smo primijenili medikamentoznu terapiju (metilfenidat, fluvoxamin), grupnu terapiju usmjerenu poboljšanju socijalnih vještina, izražavanju i razumijevanju emocija i individualizirani pristup u školi uz pomoć osobnog asistenta. U raspravi smo opisali složenost u liječenju kliničke slike komplicirane komorbiditetom i emocionalnim distresom te poznate i moguće poveznice ovih poremećaja. Liječenje ADHD-a zahtijeva multimodalni pristup i suradnju stručnjaka različitih profila. Između ostalog, pravodobno prepoznavanje udruženih simptoma i znakova drugih psihijatrijskih poremećaja i sagledavanje njihovih poveznica bitno je za sprječavanje razvoja složenije kliničke slike i određivanje terapijskih smjernica. Potrebna su daljnja istraživanja.The relationship between the attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and tics is primarily discussed through genetic, neurobiological, neurocognitive and neurochemical substrates of reduced impulse control. The comorbidity of these disorders in children and adolescents is not a rarity. In our 14-year-old patient, ADHD and simple motor tics were diagnosed at pre-school age and OCD at the age of 10. We diagnosed these disorders by DSM-IV criteria and semi-structured interviews based on it. In a multimodal treatment we used techniques from cognitive behavioural psychotherapy, psychoeducation and parental support, sensory integration therapy with a assistance dog, neurofeedback, medication therapy (methylphenidate, fluvoxamine), group therapy aimed at enhancing social skills and expressing emotions, individualized approach to learning in school with a personal assistant. We discuss the complexity of treatment of clinical presentation complicated by comorbidity and emotional distress, and some known and possible links between these disorders. Treatment of ADHD demands multimodal approach and cooperation of different professionals. Among other things, timely recognition of associated symptoms and other psychiatric disorders and their linkage is very important to prevent intensification of symptoms and signs of the disorder and to determine therapeutic guidelines. Further investigation is needed

Successful treatment of strabismus in a child with Moebius syndrome

Moebiusov sindrom (MBS) je rijetka kongenitalna bolest karakterizirana neprogresivnom unilateralnom ili bilateralnom parezom moždanih živaca, primarno facijalisa (VII.) i abducensa (VI.). Pareza facijalisa dovodi do gubitka mimike lica, smanjenog lučenja suza i sline te poremećaja okusa, a oštećenje abducensa rezultira konvergentnim strabizmom uz nemogućnost lateralnih pokreta oka. Osim navedenih, mogu biti zahvaćeni i drugi kranijalni živci (III. –XII.). Klinička slika varira ovisno o zahvaćenosti ostalih kranijalnih živaca, pa se uz simptome pareze facijalisa i abducensa pojavljuju problemi gutanja i artikulacije govora, promuklost i oštećenje sluha. Mogu biti prisutne i malformacije udova (sindaktilija, brahidaktilija, nepostojanje prstiju ruke i stopala), mikrognatija i mikrostomija. Do sad je u literaturi prikazano tristotinjak bolesnika s MBS-om, a tek nekoliko članaka opisuje operacije strabizma u sklopu njihovog liječenja. Prevalencija sindroma je od 1 - 20 slučaja na milijun porođaja (0,001 – 0,02‰). Opisujemo kombinirano liječenje konvergentnog i vertikalnog strabizma u trogodišnjeg dječaka s MBS-om. Konvergentni strabizam ispravljen je konzervativnim putem, nošenjem naočala, a vertikalni operativnim zahvatom, retropozicijom gornjeg ravnog mišića, radi postizanja paralelnih vidnih osovina koje su nužne za pravilan razvoj vidne oštrine.Moebius syndrome is a rare disease characterized by unilateral or bilateral congenital nonprogressive facial nerve palsy and abducens nerve palsy. It is associated with a wide spectrum of systemic and ocular manifestations; congenital esotropia (convergent strabismus) is common in these patients but vertical strabismus is rare. Only few articles have described results of strabismus surgery for esotropia in children, but only one reports strabismus surgery for vertical and horizontal deviation. We report a rare case of a three-year-old male child with large esotropia and limited ocular abductions along with a signifi cant vertical deviation, which is not common in classic Moebius syndrome. We used conservative approach prescribing glasses with full correction, which resolved convergent strabismus, and surgery for treating vertical strabismus by superior rectus retroposition

HOLISTIČKI PRISTUP U PREPOZNAVANJU, DIJAGNOSTICI I TERAPIJSKIM POSTUPCIMA POREMEĆAJA IZ SPEKTRA AUTIZMA

Poremećaj iz spektra autizma (eng. ASD – Autism Spectrum Disorder) je neurorazvojni poremećaj karakteriziran ponavljajućim obrascima ponašanja, interesa ili aktivnosti i problemima u socijalnoj komunikaciji i interakciji, uvjetovan složenim interakcijama između genetičkih, okolinskih i imunoloških čimbenika na mozak u razvoju. Javlja se u svim rasnim, etničkim i socioekonomskim skupinama, češći je u dječaka, iako recentne studije pokazuju porast obolijevanja djevojčica. Globalna prevalencija je od 0,76% do 2,5%, ovisno o studijama i promjenama u dijagnostičkim kriterijima. Najčešći komorbiditeti su intelektualni defi cit, epilepsija, poremećaj spavanja, poremećaj ponašanja, neurološka senzo-motorička odstupanja i gastrointestinalni i srčani problemi. Smatra se da je ASD jedan od genetički najheterogenijih neuropsihijatrijskih poremećaja s de novo mutacijama i nasljednim varijantama u oko 1000 gena. Stoga, u etiologiji ASD-a genetički čimbenici imaju veći udio od čimbenika okoline, dok najnovija istraživanja spominju i aktivaciju mikroglije, neuroinfl amaciju uzrokovanu disbiozom crijevne fl ore i imunološku disregulaciju u autističnih bolesnika. Evaluacija djeteta s ASD-om počinje identifi kacijom rizične djece suspektne na ASD. Prema smjernicama Američke pedijatrijske akademije (AAP), preporučuje se „razvojni nadzor“ u dobi 9, 15 i 30 mjeseci te specifi čni probir na autizam u dobi 18 mjeseci te ponovo s 24 i 30 mjeseci. Navedeni su upozoravajući znakovi („red fl ags“) u ranoj dobi (prve 3 godine života), predškolskoj i školskoj dobi, testovi probira i preporuke za kliničku obradu djeteta (intervju roditelja, kompletan klinički i neuropedijatrijski pregled, procjena kognitivnog statusa, senzomotorike, razvoja govora i socijalnog komuniciranja te postojanja komorbiditeta). Konačnu dijagnozu ASD-a postavljaju liječnici (neuropedijatar i dječji psihijatar) uzimajući u obzir sve što govori u prilog dijagnozi te nadalje prate razvoj djeteta. S obzirom da nema jasnih ASD biomarkera dijagnoza se postavlja na temelju ispunjenja dijagnostičkih kriterija iz DSM-5 (eng. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013.). Etiološka dijagnostika uključuje genetičku, metaboličku, neuroslikovnu obradu i EEG u indiciranim slučajevima. Terapija je multidisciplinska i visoko strukturirana, a temelji se na ranoj intervenciji. U habilitaciji i polivalentnoj neurorazvojnoj stimulaciji sudjeluju najvećim dijelom logopedi, edukacijski rehabilitatori, socijalni pedagozi, radni terapeuti, fi zioterapeuti i psiholozi. U novije vrijeme primjenjuju se i neinvazivne tehnike mozgovne stimulacije: transkranijska stimulacija istosmjernom strujom (tDCS) i transkranijska magnetska stimulacija (TMS), kojima se regulira kortikalna ekscitabilnost. Ponekad je potrebna i medikamentna terapija (atipični antipsihotici, antidepresivi, lijekovi za poremećaje spavanja, antiepileptici/stabilizatori raspoloženja). Recentna istraživanja navode gensku terapiju i drugu eksperimentalnu terapiju. Zaključno, napredak u etiopatogenezi, dijagnostici i liječenju djece s ASD-om ovisit će o ranom prepoznavanju i multidisciplinarnom, sveobuhvatnom holističkom pristupu temeljnih znanstvenika i kliničara različitih profi la

Correlations between Trichotillomania and Attention Deficit/Hyperactivity Disorder in children and adolescents

Glavni cilj ovog istraživanja bio je ispitati i prikazati zastupljenost poremećaja nedostatka pažnje s hiperaktivnošću (ADHD) i pojedinih podtipova ovog poremećaja kod djece i adolescenata s trihotilomanijom (TTM), a potom i elemente koji ukazuju na povezanost ovih poremećaja. Metode: U istraživanje je bilo uključeno 117 ispitanika u dobi od 8 do 17 godina. Uspoređivali smo tri skupine po primarnoj dijagnozi: TTM (N=38), ADHD (N=40) i OKP (N=39). Dijagnoze su postavljene prema kriterijima iz DSM-IV. Od mjernih instrumenata korišteni su; Skala suočavanja sa stresom (SUO, Vulić-Prtorić, 2002.), Test za deficit pažnje i hiperaktivnost (ADHDT, Gilliam, 1995.), Youth Self Report (YSR, Achenbach and Rescorla, 2001.) te upitnici konstruirani za ovo istraživanje. Rezultati: Postoji visoka zastupljenost udruženih psihijatrijskih poremećaja kod sve tri skupine. Kod ispitanika s TTM-om najzastupljeniji je komorbiditet s ADHD-om (n=6) i tikovima (n=5). Ispitanici s TTM-om imaju značajno više znakova i simptoma impulzivnosti, rubno nepažnje i viši ukupni kvocijent ADHD-a od ispitanika s OKP-om. Kod ispitanika s istodobno dijagnosticiranom TTM-om i ADHD-om u kliničkoj slici ADHD-a dominiraju znakovi i simptomi hiperaktivnosti-impulzivnosti. Djeca i adolescenti s TTM-om i ADHD-om imaju značajno manje internaliziranih problema i niže razine rezultata na skalama koje mjere anksioznost, depresivnost i povučenost u odnosu na ispitanike s OKP-om. Djeca i adolescenti s TTM-om i ADHD-om znatno češće grizu nokte u odnosu na djecu i adolescente s OKP-om. Zaključak: Rezultati ispitivanja proširuju spoznaje o TTM-i kao poremećaju kod kojeg uz internalizirane postoji i znatna zastupljenost eksternaliziranih problema. Iako zbog ograničenja nemaju čvrstu prediktivnu vrijednost, rezultati ove studije doprinos su uočavanju povezanosti TTM-e i ADHD-a što je doprinos prevenciji, boljem razumijevanju kliničke slike i planiranju liječenja ovih poremećaja. Za sada možemo samo pretpostaviti višu vjerojatnost za razvoj TTM-e kod djece i adolescenata s ADHD-om, a dobiveni rezultati upućuju da je razumno nastaviti istraživati ovaj problem.The main goal of this research was to analyse and show the prevalence of ADHD and certain subtypes of this disorder in children and adolescents diagnosed with TTM and the elements which show their connection. Methods: There were 117 participants between the ages of 8 and 17 included in the research. We were comparing three groups with the diagnosis of: TTM (N=38), ADHD (N=40) and OCD (N=39). Diagnoses were determined by the criteria of DSM-IV. We used The Coping Strategies Inventory for Children and Adolescents (SUO), Attention Deficit/Hyperactivity Disorder test (ADHDT),Youth Self Report (YSR). Results: By all three groups of participants there is a high prevalence of psychiatric comorbidity. ADHD is the most prevalent comorbid disorder (n=6) by the participants with TTM. The participants with TTM have a higher quotient of ADHD than those with OCD, more signs and symptoms of impulsivity and attention deficit. The children and adolescents with TTM and ADHD have less combined internalizing problems and lower levels of results on scales which measure anxiety, depression and withdrawal in reference to the participants with OCD. The children and adolescents with TTM and ADHD bite thier nails considerably more often than children and adolescents with OCD. Conclusion: The results of examining the connection of TTM and ADHD indicate the validity of set hypothesis and widen cognitions about TTM as a disorder by which together with internalized problems there is a considerable prevalence of externalized problems. Although the results of this study due to limitations, do not have firm predicative value, they considerably contribute to better understanding and planning the treatment of these disorders. For the time being we can only guess the existence of higher risk for the development of TTM in children and adolescents with ADHD, but the obtained results indicate that this problem should be further researched