Een nieuwe kijk op ADHD

De rol van executief functioneren en motivatie
06/05/2016
Pier Prins, Reinout Wiers, Saskia van der Oord, Sebastiaan Dovis
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De Psycholoog 2016-5 Cover
Issue 5

Samenvatting

EXECUTIVE FUNCTIONING AND MOTIVATION IN ADHD

S. DOVIS, S. VAN DER OORD, R.W. WIERS & P.J.M. PRINS

ADHD symptoms are proposed to result from deficits in executive functioning (EF) and motivation. We discuss reinforcement effects on the assessment of working memory (the ef considered most impaired in ADHD) and its components (short-term memory and the central executive). Conclusions: (1) both executive- and motivational deficits give rise to the working memory (WM) problems of children with ADHD, (2) within both the combined subtype (ADHD-C) and the inattentive subtype of ADHD (ADD) 22% of children have motivational deficits, (3) 69% of children with ADHD-C and 37% of children with ADD are impaired on WM, (4) only children with ADHD-C are impaired on short-term memory, (5) WM and motivation represent independent neuropsychological domains, and (6) problems with task-persistence in ADHD-C result from motivational deficits.

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  • Samenvatting
  • Tekorten in executief functioneren
  • Tekorten in motivatie
  • Relatie tussen executief functioneren en motivatie
  • De invloed van motivatie op werkgeheugen
  • Componenten werkgeheugen
  • Verschillen tussen ADHD subtypen3
  • Prevalentie tekorten in executief fuctioneren en motivatie
  • Klinische implicaties
  • Voetnoten
  • Literatuurlijst
  • Over de auteur
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‘[T]he power of attention is different, not only in different individuals, but also at different times’ (Crichton, 1798, p.255). Ruim tweehonderd jaar geleden onderkende de Schotse arts Alexander Crichton al het belang van de relatie tussen executief functioneren en motivatie bij mensen met aandachtsproblemen. Ook in het ADHD-onderzoek van nu speelt deze relatie een cruciale rol. Sebastiaan Dovis, Saskia van der Oord, Reinout Wiers en Pier Prins geven een uiteenzetting.

(Crichton, 1798, p.255)9 Attention Deficit-Hyperactivity Disorder (ADHD) is een in hoge mate erfelijke ontwikkelingsstoornis (Nikolas & Burt, 2010)31, die wereldwijd naar schatting vijf procent van de kinderen treft (Faraone et al., 2015)20. Kinderen met adhd hebben vaak moeite hun aandacht vast te houden, zijn chaotisch en slordig, snel afgeleid, vergeetachtig, praten veel, zijn vaak druk, bewegelijk, ongeduldig en impulsief (American Psychiatric Association, 2013)2. Deze kenmerken hebben vaak een negatieve invloed op het presteren op school en hun relaties met anderen binnen en buiten het gezin, wat weer kan leiden tot een negatief zelfbeeld (Barkley, 2006)4. Ook op volwassen leeftijd zorgt ADHD vaak voor problemen in het dagelijkse functioneren, onder andere in het gezin, op het werk en in sociale relaties (Barkley et al., 2008)5.

Hoewel ADHD wordt gediagnosticeerd op basis van gedragssymptomen, suggereert zowel theorie als onderzoek dat ADHD-symptomen veroorzaakt worden door onderliggende tekorten in onder andere executief functioneren en motivatie (bijv. Luman et

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