16 research outputs found
Povezanost trihotilomanije i poremeÄaja nedostatka pažnje s hiperaktivnoÅ”Äu 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 Å”irem smislu konverzivni poremeÄaj je somatiformni poremeÄaj (DSM - IV., 1996.). Psihogeni ili neepileptiÄki napadaji (pseudokonvulzije) jedan su od 4 podtipa konverzivnog poremeÄaja. S obzirom na osobitosti razvoja i pojedinih razvojnih faza diferencijalna dijagnostika psihogenih napadaja kod djece i adolescenata Äesto je vrlo zahtjevna. Glavni zadatak je razlikovati konverzivni poremeÄaj od organskih smetnji. Diferencijalna dijagnostika zahtijeva i razmatranje moguÄnosti postojanja obaju poremeÄaja istodobno. Jedini naÄin da se, ako je potrebno, adekvatno lijeÄi neuropedijatrijski i / ili pedopsihijatrijski poremeÄaj jest pravilno postavljena dijagnoza, Å”to najÄeÅ”Äe zahtijeva dobru suradnju neuropedijatra, pedopsihijatra, psihologa i kvalitetnu dijagnostiÄku opremu. Prikazana dva sluÄaja na zanimljiv naÄin meÄusobno su isprepletena, inducirana i podržavajuÄa u psihijatrijsko / neuroloÅ”kom etiopatogenetskom tijeku. ShvaÄena su kao mijeÅ”ani pedopsihijatrijski / neuropedijatrijski sluÄajevi i upuÄuju na znaÄenje suradnje subspecijalistiÄkih timova i potrebu dobrog poznavanja suraÄujuÄih struka, katkad i do "najsitnijih" kliniÄkih i drugih osobitosti pojedinih sindroma.Conversion disorder is somatoform disorder (DSM ā 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 syndromeās phenomenology
Imaju li ortoptiÄke vježbe utjecaj na djecu i adolescente s poremeÄajem nedostatka pažnje s hiperaktivnoÅ”Äu 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 ortoptiÄke vježbe koje smanjuju simptome insuficijencije konvergencije (IK) i unaprjeÄuju stereovid utjecaj i na djecu koja uz dijagnozu IK imaju i poremeÄaj pažnje s hiperaktivnoÅ”Äu (attention deficit/hyperactivity disorder, ADHD). OrtoptiÄka terapija je provedena na 50 djece s ADHD-om i istodobno dijagnosticiranom IK. Terapija je ukljuÄivala vježbe kod kuÄe i vježbe u ortoptiÄkom kabinetu na sinoptoforu. Mjerena je bliza toÄka konvergencije (BTK) i binokularni vid na stereotestovima i sinoptoforu prije, tijekom i poslije terapije. Ispitanici su pokazali znaÄajno poboljÅ”anje (p<0,05) u BTK i testovima binokularnog vida nakon ortoptiÄkih vježbi. PronaÄena je statistiÄki znaÄajna korelacija izmeÄu poboljÅ”anja BTK i stereovida (Lang I.), Å”to upuÄuje na zakljuÄak da je poboljÅ”anje binokularnog vida moguÄe u djece i adolescenata s IK i ADHD-om. Prema rezultatima naÅ”eg istraživanja ortoptiÄka terapija dovodi do poboljÅ”anja BTK i istodobnog
poboljÅ”anja binokularnog vida u djece s ADHD-om i IK. Kako unaprjeÄenje binokularnog vida ima pozitivan uÄinak na kvalitetu rada na blizinu i istodobno smanjuje nespecifiÄne vidne simptome koje Äesto imaju djeca s ADHD-om i IK, moguÄe je da ortoptiÄka terapija može utjecati i na poboljÅ”anje koncentracije, Å”to mislimo da je razumno dalje ispitati. Potrebna su daljnja ispitivanja koja bi utvrdila utjeÄu li ortoptiÄke vježbe i kako na koncentraciju i pažnju
Holistic approach in the treatment of a boy with Touretteās disorder
Touretteov poremeÄaj (TP) neurorazvojni je poremeÄaj s kombiniranim motoriÄkim i vokalnim tikovima. Etiologija bolesti nije jasna,
ali rezultati istraživanja upuÄuju na važnost genetiÄkih faktora. U radu je opisan sluÄaj holistiÄkog pristupa u lijeÄenju desetogodiÅ”njeg
djeÄaka s Touretteovim poremeÄajem. Primijenjena farmakoterapija bila je usmjerena na komorbidna stanja, a ne na same tikove.
Remisija je uslijedila nakon godinu dana lijeÄenja.Touretteās 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 Touretteās 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 poremeÄaj. U DijagnostiÄkom i statistiÄkom priruÄniku mentalnih poremeÄaja (DSM-V, 2013.)
svrstan je u skupinu s opsesivno-kompulzivnim i njemu srodnim poremeÄajima. Trihilomanija ima i karakteristike poremeÄaja
impulsa i navika. Prvi simptomi trihilomanije najÄeÅ”Äe se pojavljuju u adolescenciji. KliniÄka slika u djece i adolescenata Äesto je
komplicirana postojanjem komorbiditeta. NajÄeÅ”Äe opisivani komorbiditet su anksioznost i depresija iz podruÄja osjeÄaja i
raspoloženja, a rjeÄi su tikovi, hiperkinetski i opsesivno-kompulzivni poremeÄaj, razliÄiti oblici regresivnog ponaÅ”anja i neki drugi.
Prikazana su dva bolesnika kod kojih je prepoznavanje poremeÄaja bilo otežano time Å”to djeca i adolescenti nerado priznaju trihilomaniju,
a daljnje lijeÄenje bilo je dijelom multidisciplinarno i u mnogo Äemu je ovisilo o komorbiditetu. U prvom prikazu etiopatogeneza
je najveÄim dijelom emocionalna. U drugom prikazu prateÄi poremeÄaj je iz skupine neurorazvojnih poremeÄaja. Odabir
psihoterapijske tehnike i Å”iri pristup lijeÄenju u cijelosti su ovisili o komorbiditetu i zahtjevali su suradnju djeÄjeg psihijatra sa
struÄnjacima iz drugih podruÄja pedijatrijske medicine. Mislimo da istraživanja ovog poremeÄaja treba ustrajno i dalje usmjeravati
otkrivanju izravne i druge povezanosti trihilomanije i komorbiditeta, kako bi se omoguÄilo Å”to primjerenije i uÄinkovitije prepoznavanje
i lijeÄenje ovog poremeÄaja.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 poremeÄaja nedostatka pozornosti s hiperaktivnoÅ”Äu (ADHD), opsesivno-kompulzivnog poremeÄaja (OKP) i tikova
primarno
se opisuje kroz genetiÄke, neurobioloÅ”ke, neurokognitivne i neurokemijske supstrate smanjene inhibicije motoriÄkog
odgovora.
Komorbiditet ovih poremeÄaja u djece i adolescenata nije rijetkost. U predÅ”kolskoj dobi u naÅ”eg 14-godiÅ”njeg pacijenta
dijagnosticirani su ADHD i tikovi, a potom u desetoj godini i OKP. PoremeÄaji su dijagnosticirani prema kriterijima iz DSM-IV. i uporabom
polustrukturiranih intervjua koji se na njemu temelje. U multimodalnom pristupu lijeÄenju 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 poboljŔanju socijalnih
vjeÅ”tina, izražavanju i razumijevanju emocija i individualizirani pristup u Å”koli uz pomoÄ osobnog asistenta. U raspravi smo opisali
složenost u lijeÄenju kliniÄke slike komplicirane komorbiditetom i emocionalnim distresom te poznate i moguÄe poveznice ovih
poremeÄaja.
LijeÄenje ADHD-a zahtijeva multimodalni pristup i suradnju struÄnjaka razliÄitih profila. IzmeÄu ostalog, pravodobno
prepoznavanje udruženih simptoma i znakova drugih psihijatrijskih poremeÄaja i sagledavanje njihovih poveznica bitno je za sprjeÄavanje
razvoja složenije kliniÄke slike i odreÄivanje 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 luÄenja
suza i sline te poremeÄaja okusa, a oÅ”teÄenje abducensa rezultira konvergentnim strabizmom uz nemoguÄnost lateralnih pokreta
oka. Osim navedenih, mogu biti zahvaÄeni i drugi kranijalni živci (III. āXII.). KliniÄka slika varira ovisno o zahvaÄenosti ostalih kranijalnih
živaca, pa se uz simptome pareze facijalisa i abducensa pojavljuju problemi gutanja i artikulacije govora, promuklost i oÅ”teÄenje
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 Älanaka opisuje operacije strabizma u
sklopu njihovog lijeÄenja. Prevalencija sindroma je od 1 - 20 sluÄaja na milijun poroÄaja (0,001 ā 0,02ā°). Opisujemo kombinirano
lijeÄenje konvergentnog i vertikalnog strabizma u trogodiÅ”njeg djeÄaka s MBS-om. Konvergentni strabizam ispravljen je konzervativnim
putem, noÅ”enjem naoÄala, a vertikalni operativnim zahvatom, retropozicijom gornjeg ravnog miÅ”iÄa, radi postizanja paralelnih
vidnih osovina koje su nužne za pravilan razvoj vidne oŔtrine.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
HOLISTIÄKI PRISTUP U PREPOZNAVANJU, DIJAGNOSTICI I TERAPIJSKIM POSTUPCIMA POREMEÄAJA IZ SPEKTRA AUTIZMA
PoremeÄaj iz spektra autizma (eng. ASD ā Autism Spectrum Disorder) je neurorazvojni poremeÄaj karakteriziran ponavljajuÄim
obrascima ponaŔanja, interesa ili aktivnosti i problemima u socijalnoj komunikaciji i interakciji, uvjetovan složenim interakcijama
izmeÄu genetiÄkih, okolinskih i imunoloÅ”kih Äimbenika na mozak u razvoju. Javlja se u svim rasnim, etniÄkim i
socioekonomskim skupinama, ÄeÅ”Äi je u djeÄaka, iako recentne studije pokazuju porast obolijevanja djevojÄica. Globalna
prevalencija je od 0,76% do 2,5%, ovisno o studijama i promjenama u dijagnostiÄkim kriterijima. NajÄeÅ”Äi komorbiditeti su intelektualni defi cit, epilepsija, poremeÄaj spavanja, poremeÄaj ponaÅ”anja, neuroloÅ”ka senzo-motoriÄka odstupanja i gastrointestinalni
i srÄani problemi.
Smatra se da je ASD jedan od genetiÄki najheterogenijih neuropsihijatrijskih poremeÄaja s de novo mutacijama i nasljednim
varijantama u oko 1000 gena. Stoga, u etiologiji ASD-a genetiÄki Äimbenici imaju veÄi udio od Äimbenika okoline, dok najnovija
istraživanja spominju i aktivaciju mikroglije, neuroinfl amaciju uzrokovanu disbiozom crijevne fl ore i imunoloŔku disregulaciju
u autistiÄnih bolesnika.
Evaluacija djeteta s ASD-om poÄinje identifi kacijom riziÄne djece suspektne na ASD. Prema smjernicama AmeriÄke pedijatrijske
akademije (AAP), preporuÄuje se ārazvojni nadzorā u dobi 9, 15 i 30 mjeseci te specifi Äni probir na autizam u dobi 18
mjeseci te ponovo s 24 i 30 mjeseci. Navedeni su upozoravajuÄi znakovi (āred fl agsā) u ranoj dobi (prve 3 godine života),
predÅ”kolskoj i Å”kolskoj dobi, testovi probira i preporuke za kliniÄku obradu djeteta (intervju roditelja, kompletan kliniÄki i
neuropedijatrijski pregled, procjena kognitivnog statusa, senzomotorike, razvoja govora i socijalnog komuniciranja te postojanja
komorbiditeta). KonaÄnu dijagnozu ASD-a postavljaju lijeÄnici (neuropedijatar i djeÄji psihijatar) uzimajuÄi u obzir sve Å”to
govori u prilog dijagnozi te nadalje prate razvoj djeteta. S obzirom da nema jasnih ASD biomarkera dijagnoza se postavlja na
temelju ispunjenja dijagnostiÄkih kriterija iz DSM-5 (eng. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,
2013.). EtioloÅ”ka dijagnostika ukljuÄuje genetiÄku, metaboliÄku, neuroslikovnu obradu i EEG u indiciranim sluÄajevima.
Terapija je multidisciplinska i visoko strukturirana, a temelji se na ranoj intervenciji. U habilitaciji i polivalentnoj neurorazvojnoj
stimulaciji sudjeluju najveÄim 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 (atipiÄni antipsihotici, antidepresivi, lijekovi za poremeÄaje spavanja, antiepileptici/stabilizatori
raspoloženja). Recentna istraživanja navode gensku terapiju i drugu eksperimentalnu terapiju.
ZakljuÄno, napredak u etiopatogenezi, dijagnostici i lijeÄenju djece s ASD-om ovisit Äe o ranom prepoznavanju i multidisciplinarnom, sveobuhvatnom holistiÄkom pristupu temeljnih znanstvenika i kliniÄara razliÄitih profi la
Correlations between Trichotillomania and Attention Deficit/Hyperactivity Disorder in children and adolescents
Glavni cilj ovog istraživanja bio je ispitati i prikazati zastupljenost poremeÄaja nedostatka pažnje s hiperaktivnoÅ”Äu (ADHD) i pojedinih podtipova ovog poremeÄaja kod djece i adolescenata s trihotilomanijom (TTM), a potom i elemente koji ukazuju na povezanost ovih poremeÄaja. Metode: U istraživanje je bilo ukljuÄeno 117 ispitanika u dobi od 8 do 17 godina. UsporeÄivali 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 koriÅ”teni su; Skala suoÄavanja sa stresom (SUO, VuliÄ-PrtoriÄ, 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 poremeÄaja 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 znaÄajno viÅ”e znakova i simptoma impulzivnosti, rubno nepažnje i viÅ”i ukupni kvocijent ADHD-a od ispitanika s OKP-om. Kod ispitanika s istodobno dijagnosticiranom TTM-om i ADHD-om u kliniÄkoj slici ADHD-a dominiraju znakovi i simptomi hiperaktivnosti-impulzivnosti. Djeca i adolescenti s TTM-om i ADHD-om imaju znaÄajno manje internaliziranih problema i niže razine rezultata na skalama koje mjere anksioznost, depresivnost i povuÄenost u odnosu na ispitanike s OKP-om. Djeca i adolescenti s TTM-om i ADHD-om znatno ÄeÅ”Äe grizu nokte u odnosu na djecu i adolescente s OKP-om. ZakljuÄak: Rezultati ispitivanja proÅ”iruju spoznaje o TTM-i kao poremeÄaju kod kojeg uz internalizirane postoji i znatna zastupljenost eksternaliziranih problema. Iako zbog ograniÄenja nemaju Ävrstu prediktivnu vrijednost, rezultati ove studije doprinos su uoÄavanju povezanosti TTM-e i ADHD-a Å”to je doprinos prevenciji, boljem razumijevanju kliniÄke slike i planiranju lijeÄenja ovih poremeÄaja. Za sada možemo samo pretpostaviti viÅ”u vjerojatnost za razvoj TTM-e kod djece i adolescenata s ADHD-om, a dobiveni rezultati upuÄuju 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