Bağlanma ve emosyon regülasyonunun DEHB'de eşlik eden anksiyete belirtileri ile ilişkisi
The relationship of attachment and emotion regulation with the anxiety symptoms associated with ADHD
Yazar: HAZAL AKMAN
Danışman: PROF. DR. BURAK DOĞANGÜN
İstanbul Üniversitesi-Cerrahpaşa / Cerrahpaşa Tıp Fakültesi / Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2021
Konu: Psikiyatri = Psychiatry
Dizin: Anksiyete = Anxiety ; Anksiyete bozuklukları = Anxiety disorders ; Bağlanma = Attachment ; Duygu düzenleme = Emotion regulation ; Hiperaktiviteli dikkat eksikliği bozukluğu = Attention deficit disorder with hyperactivity

Özet:
Amaç: DEHB ve anksiyete bozuklukları, çocukluk çağında en sık görülen ruhsal sorunlardandır. Bu çalışma aracılığıyla DEHB tanılı çocuklarda eşlik eden anksiyete belirtileri ile bağlanma stilleri ve  emosyon regülasyon  becerileri arasındaki ilişkinin incelenmesi amaçlanmıştır. 
Yöntem: Çalışmaya kliniğimize başvuran, 8-13 yaş arasında, en az son 6 aydır medikal tedavi almayan DEHB tanılı hastalar ve gönüllü sağlıklı çocuklar dahil edilmiştir. Katılımcı çocuklar ile K-SADS görüşmesi yapılmış, sosyodemografik veri formu, Turgay DEHB Ölçeği, ÇADÖ-Y Ebeveyn Formu, Duygu Ayarlama Ölçeği, Kerns Güvenli Bağlanma Ölçeği, ÇADÖ-Y Çocuk Formu doldurtulmuştur. Örneklemin istatistiksel analizi, ÇADÖ ebeveyn formunda total anksiyete T skoru 70'in altında olan 74 DEHB tanılı çocuk, ÇADÖ ebeveyn formunda total anksiyete T skoru 70 ve üzerinde olan 26 DEHB tanılı çocuk ile 100 sağlıklı kontrolün verileri üzerinden yapılmıştır.
Bulgular: Anksiyete bozukluğu + ve - DEHB gruplarında ebeveynlere güvensiz bağlanma özelliklerinin ve duygu regülasyonunda güçlüklerin sağlıklı kontrol grubuna göre anlamlı olarak daha fazla olduğu saptanmıştır. Anksiyete bozukluğu + ve - DEHB grupları arasında bağlanma açısından anlamlı bir farklılık bulunmazken anksiyete bozukluğu + DEHB grubunda duygu regülasyon güçlüklerinin anksiyete bozukluğu - DEHB grubuna göre anlamlı olarak daha fazla olduğu görülmüştür. 
Sonuç: Çalışmamızda DEHB'li çocukların sağlıklı gelişen çocuklara göre bağlanma ilişkilerinin daha güvensiz ve emosyon regülasyon becerilerinin daha kötü olduğu, DEHB tanılı çocuklarda anksiyete düzeylerindeki artış ile güvensiz bağlanmanın ve emosyon disregülasyonunun ilişkili olduğu, anksiyete bozukluğu eşlik eden DEHB tanılı çocukların anksiyete bozukluğu eşlik etmeyen DEHB tanılı çocuklara göre emosyon regülasyon becerilerinin daha kötü olduğu sonuçları saptanmıştır.
Anahtar Sözcükler: DEHB, Anksiyete Bozukluğu, Bağlanma, Emosyon Regülasyonu

Abstract:
Objective: Attention deficit hyperactivity disorder is one of the most common pyschiatric problems in childhood. The prevalence of anxiety symptoms accompanying this disorder is also very high. It is known that these conditions affect academic and social functionality of children significantly. In studies conducted to date, early attachment styles have been shown to have influence on children's cognitive and psychosocial development.  Difficulties in emotion regulation skills are also shown to be associated with childhood psychopathologies. The aim of this study was to investigate the relationship between comorbid anxiety symptoms, attachment styles and emotion regulation skills in children with attention deficit hyperactivity disorder. 
Method: 8-13-year-old patients, who admitted to our clinic diagnosed with ADHD for the first time, or previously diagnosed with ADHD, but have not received medical treatment for at least the last 6 months and volunteer healthy controls were included in the study. K-SADS, which is a semi-structured diagnostic interview was conducted with the participating children. Those who were diagnosed with psychotic disorders, eating disorders or autism spectrum disorders were excluded from the sample.  Mothers of the children completed the sociodemographic data form, which was prepared by the researcher, Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale, The Revised Child Anxiety and Depression Scale-Parent Version (RCADS-P) and The Emotion Regulation Checklist, whereas children completed the Kerns' Security Scale (KSS) and The Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV). The statistical analysis of the sample was done with data of 74 patients diagnosed with ADHD and had <70 scores from RCADS-P (ADHD+/anxiety disorder- group), 26 patients diagnosed with ADHD and had ≥70 scores from RCADS-P (ADHD+/anxiety disorder+ group) and 100 healthy controls. Additionally, correlation analysis was done with data of total 100 ADHD patients.
Results: In our study, no statistically significant difference was found between ADHD +/anxiety disorder +, ADHD +/anxiety disorder - and the healthy control groups in terms of age, gender, class, maternal and paternal ages, educational status and family unity. In ADHD +/anxiety disorder - and  ADHD +/anxiety disorder + groups, the family income level was found to be significantly lower than the healthy control group and the birth order of the child among the siblings was found to be significantly higher in these groups compared to the healthy control group. When the groups were compared  in terms of the number of children in the family, it was observed that the number of children in the ADHD +/anxiety disorder - and 
ADHD+ /anxiety disorder + groups were significantly higher than the healthy control group. In the ADHD +/anxiety disorder- and ADHD +/anxiety disorder + groups, the rate of psychiatric illness in the family was significantly higher than the healthy control group. In ADHD groups with and without an anxiety disorder, insecure attachment characteristics to parents and difficulties in emotion regulation were found to be significantly higher  than  the healthy control group. When ADHD groups with and without an anxiety disorder were compared to each other, there was no significant difference between them in terms of attachment, but it was observed that emotion regulation difficulties were significantly higher in the ADHD group with an anxiety disorder than the ADHD group without an anxiety disorder. While no significant correlation was found between the severity of ADHD symptomatology and attachment, a significant positive correlation was found between difficulty in emotion regulation and  the severity of ADHD symptomatology. It was observed that insecure attachment to parents and dysregulation of emotions increase with the increase in anxiety level in children with ADHD. No significant correlation was found between attachment and emotion  regulation skills.
Conclusion: In our study, children with ADHD had more insecure attachment relationships with their parents and worse emotion regulation skills than healthy children. In children with ADHD, the severity of ADHD symptoms and accompanying behavioral problems were assiociated with emotional dysregulation and increase in anxiety levels were associated with insecure attachment patterns and emotional dysregulation.   ADHD symptomatology was found to be more severe in children diagnosed with ADHD with an anxiety disorder compared to children diagnosed with ADHD without any anxiety disorder. Children diagnosed with ADHD with an anxiety disorder were found  to have worse emotion regulation skills than children diagnosed with ADHD without any anxiety disorder. No significant difference was found between children with ADHD with comorbid anxiety disorder and children with ADHD without any comorbid anxiety disorder in terms of attachment relationships with their parents. No statistically significant relationship was found between the severity of ADHD symptoms and accompanying behavioral problems and attachment characteristics in children with ADHD. Attachment and emotion regulation skills were also not found to be related to each other in these children. Since no study examining attachment and emotion regulation skills in child ADHD patients with comorbid anxiety disorders was found in the literature, it is thought that our study will contribute to the literature in this area. Therapeutic interventions focusing on the difficulties in such areas gain importance in the treatment and follow-up of these children.
Keywords: Attention Deficit Hyperactivity Disorder, Anxiety Disorder, Attachment, Emotion Regulation