Tlhahlobo ea ts'ebetsong ea ts'ebetso ea bolaoli le ts'ebetso ea meriana ho bana le bacha. (2012)

Tsamaiso ea Tsamaiso

Ho laola le ho tataisa boits'oaro tikolohong e lulang e fetoha, boko bo hloka sistimi e hokahanyang. Teena ES o ikarabella bakeng sa ts'ebetso e ts'oanang ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea mekhoa e mengata e lebisang ho tsebiso e lebisitsoeng ho sepheo, boikaelelo ba mosebetsi, boits'oaro le boitšoaro bo botle hammoho le ho rala, ho hopola mohopolo, ho feto-fetoha ha kelello, ho sitisa karabelo, taolo ea tšusumetso le ho beha leihlo ea action (Robinson, Goddard, Dritschel, Wisley, & Howlin, 2009). EF e bua ka boiphihlelo bo bongata bo hlokahalang ho itokisetsa le ho etsa boits'oaro bo rarahaneng (Ozonoff et al., 2004). Ho se sebetse hantle ha ES ho ama bokhoni ba EF ba ngoana ba ho sekaseka, ho rala, ho beha lintho pele, ho hlophisa, ho qala le ho phethela ketsahalo ka nako. Ho sebelisa nako le nako ea likopano ho fetoha bothata bo boholo. Bana bana ba hloka likhopotso khafetsa ka lebaka la mathata a ho sebetsa ka hlooho. Ha ba khone ho fetola boits'oaro kapa merero ho latela litlhoko tsa tikoloho mme ba thatafalloa ke ho etsa moralo o mong ha ba hlahisoa ka maemo a macha kapa mesebetsi. Ba phela haholo mona le joale, ha ba sebetsane le lintho tse hanyetsanang, 'me ha ba khone ho tloaela liphetoho kapa ho fetola maemo kapele. Ha li fetohe habonolo, li ka tšoarella kemisong e le 'ngoe, li tsepamisa maikutlo morerong o le mong hape li tsitsa monahanong oa tsona. Litšebelisanong tsa bona tsa sechaba ba lebelletse hore lithaka tsa bona le batsoali ba itshware ka tsela e boletsoeng esale pele mme ha sena se sa etsahale ba leka ho laola boemo, ba arabela ka mokhoa o fetelletseng kapa ba ea mokhoeng oa ho koala.

Neurobiology

ES e kopantsoe le likhokahano tse fapaneng ka pele, parietal le occipital cortices, thalamus le cerebellum (Jurado le Roselli, 2007). E hokahantsoe ka letoto la lipotoloho tse hokahanyang sebaka ka seng sa tsamaiso ea methapo e bohareng. Thli-circuits li simoloha sebakeng sa dorsolateral preambilial cortex (PFC) / orbitofrontal cortex (OFC), projeke ka striatum, synapse ho boemo ba globus pallidus, substrantia nigra le thalamus le thomete le ho khutlela hantle ho PFCs (Narushima, Paradiso, Moser, Jorge, & Robinson, 2007). Each potolohileng e laola mesebetsi e itseng. Potoloho e nang le boikarabello bo boholo ba ho hokahanya EF e sebakeng sa mantlha. Lithuto tse sebetsang tsa ho nahana ka mokhoa oa ts'ebetso li amme PFC e le sebaka sa mantlha sa ts'ebetso ea cortical nakong ea mesebetsi e kenyang EF (Elliott, 2003).

Neurochemistry

Teena PFC e laola tlhokomelo le boitšoaro ka marangrang a lisele tse hokahaneng tsa pyramidal tse itšetlehileng haholo ka tikoloho ea tsona ea methapo. Liphetoho tse nyane ho catecholamines, norepinephrine kapa dopamine, li ka ba le litlamorao ho ts'ebetso ea PFC (ho leka-lekana ha lik'hemik'hale). Norepinephrine le dopamine li lokolloa ho PFC ho latela boemo ba ngoana ba mofere-fere; ha nyane haholo (nakong ea mokhathala kapa ho sithabela maikutlo) kapa e ngata haholo (nakong ea khatello ea maikutlo) e tla sitisa ts'ebetso ea PFC. Ho lokolloa lipalo tse lekaneng ha ngoana a le seli 'me a thahasella (Arnsten, 2009). Dopamine, neurotransmitter e ka sehloohong ea ES, e bapala karolo ea bohlokoa ho cortex ea pele ho mediate EF. Dopamine neurons e nka karolo ho fetoleleng litebello, moputso, mohopolo, ts'ebetso, tlhokomelo, likhahla le maikutlo. Ho senyeha tsamaisong ea dopaminergic ho theha motheo oa maloetse a mangata a kelello (Cohen le Carlezon, 2007).

Executive Dysfunction le Psychopathology

Tšenyo ea ho senyeha kapa ho se sebetse hantle ha tsela ea tšohanyetso le pherekano litseleng tse tsoang ho ts'oarano ea lik'hemik'hale li amana hantle le ho se sebetse hantle ha ES joalo ka ha ho bonts'itsoe ka lithuto tsa neuroimaging tse sebelisitsoeng ho hlahlojoa ha PET le fMRI (Elliott, 2003). Dysfunction ea Executive e bonts'a ho se sebetse hantle lits'ebetsong tse hokahanyang libaka tse tlasa cortical le li-lobes tse ka pele.Rosenblatt & Hopkins, 2006). Ka bobeli liphatsa tsa lefutso le tikoloho li ka kena-kenana le katleho ea ES.

Ho senyeha ha EF ho tlasa ts'ebetso ea psychopathology e bonoang maemong a mangata a kelello mme e amana haholo le sephetho sa ts'ebetso, bokooa le boits'oaro bo itseng ba bothata (Royall et al., 2002). Ho se sebetse hantle ke hona ho amang matšoao a mangata ao bana ba ka a hlahisang le (Roberts, 2006) hape e hokahane le mathata a mangata (Robinson et al., 2009).

Tlhokomelo ea ho ba le tšenyo ea ho hloka matla (ADHD)

Bana ba nang le ADHD ba na le mathata a tebileng le EF libakeng tse ngata hoo lingaka tse ling tsa mafu a kelello le litsebi tsa kelello li rerileng ho reha botjha bothata bona e le ho senyeha ha EF.r (Parker, 2011) kapa bofokoli ba bofokoli ba EF (Barkley, 2012). Mathata a mangata a boletsoeng esale pele a fumaneha ho bana ba nang le ADHD ho kenyelletsa mathata a mantlha le taolo ea nako, ho rala le ho hlophisa, ho qala le ho phethela mesebetsi ka nako, ho thatafalloa ke ho fetolela tsebo e hlakileng, boemo bo phahameng ba ho lieha, ho lebala le ho se tsebe ho sebetsa hantle. .

Mabapi le pharmacotherapy liphuputso tse ngata li amme meriana e khothalletsang, methylphenidate (MPH) le dextroamphetamine (D-AMP), ka ts'ebetso e ntlafalitsoeng ea EF, e fokotsa le hangata ho fokotsa ho senyeha ha kelello le boits'oaro ho bana ba nang le ADHD (Snyder, Maruff, Pietrzak, Cromer, & Snyder, 2008). EF e ile ea hlahlojoa ho bana ba 30 ba nang le ADHD; 15 e ne e le meriana e hlasimollang ea naïve mme 15 e ne e ntse e phekoloa ka meriana e matlafatsang. Lihlopha tsena tse peli li ne li bapisoa le taolo ea 15 e lumellanang le lilemo, thobalano le bohlale (IQ). Bana ba sa hlophisehang ba nang le ADHD ba bontšitse ho senyeha ho itseng hoa mesebetsi e fapaneng ea EF ha bana ba hlalositsoeng ba nang le ADHD ba sa ka ba bontša ho sitisoa mesebetsing efe kapa efe ea EF ntle le bofokoli ba memori ea tlhokomeliso ea sepakapaka (Kempton et al., 1999). Tekanyetso e le 'ngoe ea MPH e ne e amahanngoa le ntlafatso e matla ts'ebetsong ea kelello ea pele, ho kenyelletsa le katleho ea mosebetsi oa Hearts and Flowers EF le pono e tsoelang pele ea ts'ebetso ha e bapisoa le placebo (Green le al., 2011). Phetoho e joalo ho EF e ka sebelisoa e le lets'oao la phello ea meriana ea psychostimulant ho bana ba nang le ADHD, mofuta o kopaneng (Efron et al., 2003).

Phello ea kalafo ea li-stimulants ho ADHD e amana le litlamorao tsa bona tsamaisong ea catecholamine. Ho senyeha ha methapo ea kutlo e bakang ho hloka taolo ea mantlha ho etsahala ka lebaka la tlhekefetso ea sethala sa dopamine (Snyder et al., 2008). Li-pharmacotherapies tsohle tse amoheloang hona joale bakeng sa ADHD, tse hlasimollang le tse sa khothalletseng, li sebetsa ka ho hlahisa methapo ea kutlo ho PFC (Arnsten, 2009). Lithutong tsa ADHD, litekanyetso tse le 'ngoe tsa atomoxetine e sa susumetsang e hlahisitse litlamorao ho arabeloa ke karabo ha ho se na litlamorao le ho hopola (Marsh, Biglan, Gertenhaber, & Williams, 2009). Le ha norepinephrine reuptake inhibitor, atomoxetine e sebetsa haholo-holo ka presynaptic norepinephrine transporter blockade mme e phahamisa dopamine libakeng tse ikhethileng tsa likhoerekhoere.

Autism Spectrum Disways (ASD)

E 'ngoe ea khaello ea kelello e lulang e pheta-phetoa khafetsa ho batho ba fumanoang ke lefu la kelello ke ho se sebetse hantle. Mesebetsi ea morao-rao ea sebopeho le ts'ebetso ea ho nahana ka mokhoa oa morao-rao hammoho le lithuto tsa neuropathology le neuropsychology li fana ka tšehetso e matla ea ho nka karolo ha karolo ea pele ea cortex ho autism (Ozonoff et al., 2004). Boithuto bo 'maloa bo bapisa bana ba nang le ASD (autism le Asperger syndrome) ka lilemo le lihlopha tsa taolo e ts'oanang ea IQ li bonts'itse liphoso tsa EF (Happe, Booth, Charlton, & Hughes, 2006). Ho tšoana ka boitšoaro bo teng lipakeng tsa bakuli ba nang le liso tsa pele tsa lobe le batho ba nang le ASD ho lebisitse khopolong ea hore mekhoa e meng le e meng ea boits'oaro ea setjhaba le ASD e ka bonts'a ho hloka taolo e itseng (Robinson et al., 2009). Tlhahlobo ea lithuto tse ileng tsa hlahloba ka ho hlaka bokhoni ba EF joalo ka bokhoni ba ho rala, ho tenyetseha kelellong, thibelo, bokhoni ba ho itlhahloba le ho itlhokomela ho batho ba nang le ASD, ha ho bapisoa le sehlopha se laoloang hantle kapa tlhaiso-leseling ea tlhahlobo, e tlalehileng bofokoli ho e 'ngoe ea libaka tsena. (Thaba, 2004).

Ho na le bopaki bo matla ba hore tlhekefetso tsamaisong ea dopaminergic e amahanngoa le bofokoli ba ASD (Lenyalo, Zohar, & Westenberg, 2004; McCracken et al., 2002). Dopamine modulates motor motor, bokhoni ba tlhokomelo, boits'oaro ba sechaba le pono ea lefatše le ka ntle, tseo kaofela li sa tloaelehang ho autism (Ernst, Zametkin, Matochik, Pascualvaca, & Cohen, 1997). Mekhoa ea litlhare ea antipsychotic, e sebetsang haholo e le lihanyetsi tsa dopamine, ho kenyeletsa haloperidol le risperidone e bile lithethefatsi tse ithutoang haholo bakeng sa ho fokotsa matšoao a lefu la autism (Malone, Gratz, Delaney, & Hyman, 2005). Atypical antipsychotic risperidone e ne e le sethethefatsi sa pele se amohetsoeng ke US Food and Drug Administration (FDA) ho 2006 bakeng sa kalafo ea ho teneha e amanang le lefu la autistic, ho kenyelletsa le matšoao a khalefo, ho intša kotsi ka boomo, ho teneha ha bohale le ho fetoha ha maikutlo ka potlako. bana le bacha ba lilemo li 5 ho isa lilemong tsa 16. Bana ba tšoaroang ka risperidone ba bontšitse ho fokotsa litšitiso, khatello ea maikutlo le matšoao a bohale ha a bapisoa le placebo (Parikh, Kolevzon, le Hollander, 2008). Ho 2009, aripiprazole e boetse ea lumelloa ke FDA bakeng sa letšoao lena. Aripiprazole le risperidone e 'ngoe le e' ngoe e na le boholo bo boholo ba phello bakeng sa kalafo ea ho se ts'oanehe, ka tsela e sa tobang e bonts'a katleho e ts'oanang lipakeng tsa likhomphutha tse peli (Douglas-Hall, Curran, le Nonyana, 2011). Molao oa Serotonin o kentse letsoho lipontšong tsa boitšoaro bo pheta-phetoang (Kolevzon, Mathewson, & Hollander, 2006). Liteko tse 'maloa tse laoloang ka mokhoa o hlophisitsoeng tse ithutang ho sebetsa hoa li-SSRIs kalafong ea boitšoaro bo pheta-phetoang ho bana ba nang le ASD li tlaleha litlamorao tse sa tsitsang empa tlhahlobo ea meta ea lingoliloeng tse phatlalalitsoeng e khothalelitse phello e nyane empa e bohlokoa (Carrasco, Volkmar, & Bloch, 2012). Hape, leha e sa nkuoe e le moemeli oa sechaba ka kakaretso, phuputso ea bana ba 60,641 US ba fumanang Medicaid e tlaleha hore 56% e ne e le bonyane moriana o le mong oa psychotropic mme 20% e ne e fuoe meriana e meraro kapa ho feta ka nako e le ngoe. Lithethefatsi tsa Neuroleptic e ne e le tsona tse sebelisoang ka ho fetisisa (31%), li lateloe ke li-antidepressants (25%) le li-stimulants (22%) (Mendell et al., 2008).

Fetil Alcohol Spectrum Disorderrum (FASD)

EF e hlahisitsoe e le khaello ea mok'hadinale ho FASD, ho pepesetsoa joala ho pepesole e le sesosa se setle ho nts'etsopele ea "cortex" ea pele.Rasmussen le Bisanz, 2009). Phuputsong ea bana ba 18 (ba lilemo li 8 ho isa lilemong tsa 15) bana ba pepesitsoeng joala ba bile le mathata a mangata mehatong ea EF ea bokhoni ba ho rala, thibelo e ikhethileng, ho theha mohopolo le ho beha mabaka (Mattson, Goodman, Caine, Delis, & Riley, 1999). Bana ba nang le FASD le bona ba na le bothata bo boholo le boits'oaro bo rarahaneng bo kenyelletsang ho kopanngoa ha libaka tse ngata ho kenyelletsa ho feto-fetoha, ho rala le ts'ebeliso ea leano, tlhokomelo le memori e sebetsang ea sebaka, karabelo e telele le nako ea liqeto tse itšetlehileng ka ts'ebetso e nepahetseng ea likarolo tse fapaneng tsa boko, haholoholo liphokojoe tsa pele (Green le al., 2009).

Ha ho na meriana ea psychotropic e tobileng bakeng sa kalafo ea FASD. Ho pepesehela joala ho bakhachane ho amahanngoa le bofokoli ba EF libakeng tse ka pele tsa bolulo. Ho fanoa ka khokahano ea dopamine le norepinephrine neurotransmitter pherekano libakeng tse ka pele tsa lobes (Frankel, Paley, Marquardt, & O'Connor, 2006) boits'oaro bo bobe bo ka ba teng ho arabela ho lithethefatsi tse amang ts'ebetso ea dopaminergic ho kenyelletsa li -vuser le li-neuroleptics. Boholo ba bana bana hangata bo fuoe motsoako oa motsoako o matlafatsang le oa moloko oa bobeli oa "neuroleptic" (atypical antipsychotic).

ho tepella maikutlo

Boloetse bo boholo ba khatello ea maikutlo (MDD) bo amahantsoe le ho hloka taolo (Executive dysfunction)Fava, 2003) le bokhoni bo amanang le pele ba tlholeho (van Tol et al., 2011). Nlithuto tsa li-euro ka ho batho li tšehetsa khopolo ea hore MDD e amahanngoa le boemo ba phetisetso ea dopamine e fokotsang (Dunlop & Nemeroff, 2007). Menahano ea ho ipolaea e 'nile ea bonoa e le "qeto e mpe" e mpe e entsoeng ke motho ea bonts'a maikutlo a ho hloka kelello le menahano e tenang, e leng motho ea sa atleheng ho bona tharollo ea mathata a mang ntle le ho ipolaea. E le "setsi sa liqeto tse phahameng" sa boko, lobe e ka pele e kanna ea se sebetse ho bakuli ba ipolaeang (Hartwell, 2001). Ha ho kalafo e le 'ngoe e fumanoeng e sebetsa hantle ka mokhoa o tšoanang ho MDD kaha feela 40% ea bakuli ba fumana tšoarelo ka teko ea pele ea antidepressant. Leha lithuto tse 'maloa li sibollotse liphokotso tse ngata tse ka sebelisoang e le matšoao bakeng sa karabo ea SSRI, sena ha se na thuso lipetlele ho fihlela joale ha ho thoe boemo ba bohlokoa ba neuropsychological bo amanang le karabo ea SSRI e sa tsejoe. Leha ho le joalo, bakuli ba nang le ts'oaetso e matla ea EF ba kotsing ea ho fumana kalafo e futsanehileng (Gorlyn et al., 2008).

Bipolar Disorder

Mabapi le Bipolar Disorder (BD), khaello ea kelello e amanang le EF e hlalositsoe likarolong tsohle tsa lefu lena. Ho senyeha libakeng tse ling tsa kelello tse kang memori ea pono, ho hopola mohopolo le boitšoaro bo nkang likotsi, ho bonoe ho hlakola nakong ea lefu la ho kula empa ho senyeha libakeng tse ling tse kang ho khetha ka hloko, ho tjeka ka hloko, ho rera ka mantsoe, ho hopola mantsoe, ho tiisetsa, ho sebetsa ka lebelo le likarolo tse ling tsa EF tse joalo ka taolo ea inhibitory, inhibition ea karabelo le monahano o hlakileng, li khona ho phehella ho sa tsotelehe boemo ba hajoale ba moea (Goldberg le Chengappa, 2009). Ho ameha le ho senyeha mehatong ea ts'ebetso e kholo ho tlalehiloe lilemong tsa bocha pele ho pontšo ea pherekano (Meyer et al., 2004). Ho haella ha kelello ho tebileng ho BD ho amana le mathata a ho sebetsa ka hloko, EF le memori ea polelo ka ho boloka mesebetsi e meng joalo ka memori ea pono ea pono, ho bua ka mokhoa o phollatsi le molumo oa mantsoe. Phuputso ea 44 euthymic bipolar Outpatients e ts'oanang ha e bapisoa le taolo e tšoanang ea 46 e bontšitse hore ho senyeha ha EF le tahlehelo ea thibelo e kanna ea ba karolo ea bohlokoa ea BD ho sa tsotelehe hore na lefu lena le matla hakae kapa litlamorao tsa meriana.Mur, Portella, Martinez-Aran, Pfifarre, le Vieta, 2007).

Boithuto bo tlalehang phello ea meriana e ikhethileng ho EF ea bana le ea lilemong tsa bocha mokhatlong o mong le o mong oa BD ha oa ka oa tsebahatsoa tlhahlobisong ena. Ho sa na le ho hloka kutloano ho lingaka mabapi le ts'ebetso e nepahetseng kapa litlhare ho BD ho bana. Likhetho tsa kalafo li kenyelletsa ho ba le methapo ea maikutlo (mohlala, lithium le valproic acid) le antipsychotic atypical (risperidone, quetiapine le aripiprazole joalo ka ha e amohetsoe ke FDA). Aripiprazole haufinyane e sa tsoa amoheloa ke Health Canada hore e sebelisoe lilemong tsa bocha 13-17 ea lilemo li nang le BD (Hlakubele 2012).

Schizophrenia

Ho schizophrenia, ts'ebetso ea kelello e sebetsa hantle ho bakuli ba bangata. Mefokolo e kenyelletsa ho senyeha ka hloko, ho hopola mohopolo le EF (Goetghebeur & Dias, 2009). Menahano e sa utloahaleng, litlatsetso le lipono tse mpe (matšoao a nepahetseng) a amana le dopamine dysregulation le dopamine e ngata bokong. Ntlafatso ho tse ling empa ha se likarolo tsohle tsa kelello nakong ea kalafo ka lithethefatsi tsa atypical antipsychotic clozapine, quetiapine, olanzapine le risperidone ho tlalehiloe ho tse ling empa ha se lithuto tsohle (Harvey, Napolitano, Mao, & Gharabawi, 2003; Cuesta, Peralta, & Zarzuela, 2001). Papiso e hlophisitsoeng ka boomo, e laoloang, e sa boneng mahlo habeli, e lipakeng tse fapaneng ea litlamorao tsa ziprasidone le olanzapine ho bakuli ba kulang haholo ba nang le lefu la kelello kapa lefu la kelello le bontšitseng hore kalafo ka bobeli e ne e amana le ntlafatso ea bohlokoa ea lipalo ho tloha mohopolong, memori, memori e sebetsang lebelo la koloi le EF (Harvey, Siu, & Romano, 2004). Ha ho phapang pakeng tsa lipalo-palo lipakeng tsa meriana ena e fumanoeng ka boholo ba ntlafatso ho tloha motheong oa ntlafatso ea kelello.Harvey et al., 2004). Bakuli ba mashome a mararo a metso e mene ba neng ba arabela karabo ea li-antipsychotic tse tloaelehileng ba ile ba hlahlojoa ka betri e felletseng ea methapo ho kenyeletsa mehato ea EF: ho ithuta ka hlooho le ho bona le ho hopola, ho hopola ka potlako, ho khetha, tlhokomelo e tsitsitseng, pherekano / ts'ebetso ea makoloi le litsebo tsa koloi. ho ea kalafo le ho latela kalafo le atypical olanzapine bakeng sa libeke tse tšeletseng le likhoeli tse tšeletseng hamorao. Olanzapine e ntlafalitse bofokoli bo bong empa e se liphoso tsohle tsa kelello tse amanang le lefu la kelello le ho kenyeletsa memori ea polelo (McGurk, Lee, Jayathilake, & Meltzer, 2004). Likarabo li ne li sa bonahale li sa fetohe kapa li sa hlaka ka ho lekana hore li ka ba molemo ho tšoaea moriana o mong.

Ho Ferekanya Khatello e Qobellehang (OCD)

OCD e hokahane le ho se sebetse hantle ho hokahaneng le neuropathology ea mekhoa ea fronto-striatal (Chang, McCracken, le Piancentini, 2007) empa tsebiso ea bofokoli bo tloaelehileng e sa lumellane litlalehong tse fapaneng. Khaello e tloaelehileng e bonahala e le mathata a ho thibela le ho feto-fetoha ha bokhoni ba ho feto-fetoha leha bokhoni ba ho hlophisa bo bonahala bo sa sebetse. Ke lithuto tse fokolang tse bonts'ang liphokotso tse joalo ho bana ba nang le OCD mme liphuputsong tseo li phatlalalitse sephetho se kopane (Ornstein, Arnold, Manassis, Mendlowitz, & Schachar, 2010). Mohlala, lintlha tse fumanoeng molemong oa ho hopola le ho bua ka mokhoa o phollatsi li sa lumellane. Phuputsong e 'ngoe e amanang le taolo, bacha ba nang le OCD ba bontšitse bofokoli ba sepakapaka bo tšoanang le bakuli ba nang le liso tsa pele tsa lobe. Phuputso ea bobeli ha e tlalehe ho senyeha ha betri e ngata ea neurocognitive e kenyelletsang mehato e mengata ea EF (Chang le al., 2007). Phuputso e 'ngoe ha ea fumana phapang pakeng tsa bana ba nang le OCD le li-laola (Andres et al., 2007). Phuputso e sa tsoa feta (Ornstein et al., 2010) ea bana ba 14 ba nang le OCD le taolo e phetseng hantle e bontšitse hore bana ba nang le OCD ba bonts'itse matla a amanang le likarolo tse fapaneng tsa taolo e kholo hammoho le tšebetso e ntle ea mohopolo.

Ho fihla joale, li-SSRIs e ntse e le moriana o sebetsang ka ho fetisisa oa ho phekola matšoao a OCD le hoja tšusumetso ea bona e fokolang bofokoling ba EF e sa hlaka. Boithuto bo bong bo boletse hore serotonin e bapala karolo ea bohlokoa ts'ebetsong ea matloana a ka pele ka ho nolofalletsa puisano ea tlhahisoleseling ho tloha mothong o mong ho ea ho o mong (Huey, Putman, & Grafman, 2006) le ka ho sebelisana ha eona le dopamine (Dunlop & Nemeroff, 2007).

Puisano

Tlhahlobo ena e bontšitse bofokoli ho EF maemong a mangata a kelello ho bana le lilemong tsa bocha mme e ba fumane ba hlaha khafetsa le ka mokhoa o tšoanang maemong a kang ADHD, ASD le FASD. "Boraro" bona bo bonahala bo arolelana lits'oants'o tse tloaelehileng le boits'oaro, 'me ka nako ena ka nako e ka nkuoa e le "Mathata a Ts'ebetso ea Tsamaiso". Khaello mathateng ana e hlaha ho tsitsipano ea ka pele-subcortical e kenyelletsang dopamine ea methapo. Sena se na le moelelo taolong ea bongaka haholo-holo ho tataisa khetho ea lingaka. Phekolo ea mohala oa pele bakeng sa ADHD e ntse e le meriana e khothatsang (Hosenbocus le Chahal, 2009), leha ho le joalo ka bothata ba lefu la sethoathoa, lingaka tse peli tse nang le tumello ea FDA bakeng sa tšebeliso ea ASD ke risperidone le aripiprazole, 'me ka bobeli ba sebetsa ho tiisa botsitso ba dopaminergic. Li-stimulants ke dopamine agonists, risperidone ke mohanyetsi oa dopamine, 'me aripiprazole ke dopamine e leeme ea agonist / antagonist. Ka bobeli ba lihlopha tsena tsa meriana hangata li sebelisoa ka kopanelo ho tsamaiso ea ADHD, ASD le FASD. Ho tloaelehile ho fumana ngoana ea nang le lefu la EF a nkile ka bobeli nako e tsosang le ea risperidone. Bokamosong, ka ho nahana ka libaka tse ikhethileng ka har'a EF, ho kanna ha khonahala ho hlakisa mofuta oa bofokoli litsing tsena mme o hlahise lintlha tse ikhethang tsa EF (Happye al al., 2006) tse ka bang bohlokoa tleleniking. Sena se ka fetola tsela eo bana ba nang le mafu a EF ba laolehileng ka eona. Mathateng a mang a kang OCD, MDD le BD liphoso ha li tsamaisane ebile li rarahantsoe ke mabaka a pele ho morbid kapa co-morbid. Moetso oa khatello ea maikutlo le 'mele oa khatello ea maikutlo o boletseng esale pele hore ho ba teng ha ts'ebeliso e ntle ea tšebetso e amana le karabelo e futsanehileng ea meriana ea antidepressant ha e netefatsoe ke bopaki bo teng (McLennan le Mathias, 2010). Sena ha se monate kaha ho ba teng ha mefokolo e meng ea EF ho ka be ho sebelitse e le tataiso bakeng sa tšebeliso ea meriana ha khatello ea maikutlo. Leha ho le joalo, li-SSRIs e ne e le tsona feela litlhare tsa kalafo tse sebelisitsoeng thutong mme li-SSRI tsa morao-rao li tsoile hantle ho phekola MDD ea bana, mohlomong hobane khatello ea maikutlo e kanna ea amahanngoa le bofokoli bo matla ho dopaminergic ES eo li-SSRIs li sa e sebetseng ka kotloloho.

Ha ho na moriana o le mong o fumanoeng o khethehile ho lokisa kapa ho ntlafatsa likarolo tsohle tsa ES maemong ohle. Li-stimulants li ka thusa ka tlhokomelo le taolo ea tšusumetso, li-antiypychotic antipsychotic kapa li-anticonvulsants tse nang le maikutlo a ho feto-fetoha ha maikutlo, ho teneha, ho pheta-pheta kapa ho hlekefetsoa le li-SSRIs tse nang le matšoenyeho a feteletseng le boits'oaro bo phetellang empa moriana o le mong o ke ke oa li etsa kaofela. Ha ho makatse hore ebe matšoao ana kaofela a teng ho ngoana a le mong mme meriana e kopantsoe ho laola matšoao a mangata kamoo ho ka khonehang e lebisang ho "poly-pharmacy." Tšebeliso ea meriana ea Psychotropic ho bana le lilemong tsa bocha e ntse e le sebaka sa likhang 'me batla matshwao a tshepehang a tlhaho, ho kenyelletsa le hore na bofokoli bo itseng ba EF bo ka bapala karolo ena, ho lokafatsa tšebeliso ea bona e ntse e tsoela pele.

Litlhahiso

Khaello ea EF e tlasa mathata a mangata a kelello 'me e lokela ho tsejoa pele ho ts'ebetso ea tlhahlobo pele ho theha moralo oa taolo. Ho tseba hore na ke mefokolo efe e sa arabeng moriana o itseng kapa molemong oa tikoloho ho tla etsa hore tšebeliso ea lisebelisoa kapa maano a mang ho sebetsana le bofokoli bo joalo mme, ka ts'epo, e tla tlisa sephetho se betere. Ntle le moo, ho itšetleha ka tšebeliso ea meriana e le 'ngoe ho etsa phapang ho beha tebello e sa hlokahaleng ho moriana mme ho ka lebisa ho nyahameng ha karabelo e sa khotsofatse kapa ho "poly-pharmacy" leka ho akaretsa matšoao ohle a nang le mathata. Kamehla ho bohlokoa ho kopanya meriana le maano a mang a taolo le ho netefatsa hore moriana kapa mofuta ofe kapa ofe oa meriana ha o ame ts'ebetso ea kelello e bakang ho senyeha ho eketsehileng.

Tlhahlobo e hlophisehileng ea EF hangata e etsoa ke setsebi sa kelello kapa neuropsychologist e sebelisang tlhahlobo e lekantsoeng joalo ka Behavior Rating Inventory of Executive Function (BRIEF), Developmental Neuropsychological Battery (NEPSY II) kapa li-betri tse ling tsa liteko tsa neuropsychological. Ka bomalimabe litsebi tse joalo li kanna tsa se fumanehe habonolo litsing tse ngata mme bana ba lutse lethathamong le lelelele la ho leta ho hlahlojoa. Leha ho le joalo, moralo oa taolo o hloka ho thehwa hang hoba ngoana a bonoe. Ka mokhoa o sa reroang, tlhaiso-leseling e sebetsang ho EF ea ngoana e ka bokelloa mehloling e fapaneng ho kenyelletsa e nang le tlhahlobo e le 'ngoe moo likarolo tse fapaneng tsa ts'ebetso ea ngoana joalo ka bokhoni ba ho hlophisa, taolo ea ho ama, ts'ebetso ea tlhahisoleseling, bokhoni ba ho rala, bokhoni ba ho fetoha mosebetsi oa ho o etsa, ho qala mesebetsi / ho phethela, taolo ea nako le bokhoni ba ho rarolla mathata a ngoana li ka bonoa tsa ba tsa ngoloa. Bokhoni ba hae ba ho etsa mesebetsi e rarahaneng ea bophelo ba letsatsi le letsatsi bo ka boela ba hlahlojoa ka mokhoa o sa reroang. Matšoao a bonolo a methapo ea kutlo a ka boela a hokahana mme mehlala ea mosebetsi e hlahlojoe. Makala a lipotso a lekantsoeng, manane a ho lekola kapa sekala sa litekanyetso tse kang Barkley Deficits in Executive Functioning Scale — Children and Adolescents (BDEFS-CA) le ona a ka sebelisoa neng kapa neng ha ho khoneha. Ka ho hlophisa tlhaiso-leseling e bokelletsoeng, profil ea EF ea ngoana e ka ts'oaroa hammoho le ho sebelisoa ho qala moralo oa tsamaiso ha u ntse u emetse tlhahlobo e hlophisitsoeng haholoanyane.

Mefokolo ea EF, hang ha e fumanoe, e lokela ho tšohloa le ngoana (neng kapa neng ha ho hlokahala), batsoali le bahlokomeli ba bang ho kenyelletsa matichere. Mathateng a EF, kutlwisiso e nepahetseng ea mefokolo e ka lebisa ho amoheloeng hamolemo le ho latela litumellano kapa bolulo tse hlokahalang lapeng, sekolong le sechabeng ho qoba mathata kapa maemo a tlokotsi. Tšebeliso le tšusumetso ea moriana mefuteng e meng ea bofokoli kapa libaka tse reretsoeng, ha ho bontšoa, e lokela ho hlakisoa hammoho le mefokolo ea bona le tlhoko ea kalafo e tšoanang. Mathateng a mang, ho bohlokoa ho theha lenaneo la koetliso ea botsoali ho ruta mekhoa ea botsamaisi joalo ka ho senya mesebetsi e mengata e le ho fokotsa khatello le tšebelisano 'moho ho rarolla mathata pakeng tsa ngoana le mohlokomeli ho qoba likhohlano tsa matla le ho phatloha. boits'oaro (Greene, 2005). Mekhoa e tloaelehileng ea ho ba motsoali le taolo ea boitšoaro e sebetsang ho bana ba tloaelehileng, ho kenyelletsa le meputso kapa litlamorao, ha e ea ba le katleho e kholo le bana ba nang le mathata a EF. Hape, hang ka beke ho fana ka tlhabollo ntle le boiteko ba ho kenya bolulo libakeng tsa "bohlokoa tsa ts'ebetso" maemong a tlhaho ha ho na monyetla oa ho atleha ho mokuli ea nang le EF e haelloang (Barkley, 2012). Tsamaiso e sebetsang e hloka ho ba mekhahlelo e mengata ha e kopana le mekhatlo e mengata le litsebi tse hulang lisebelisoa tsa eona mmoho mme e hokahana ka kopanelo ntle le ho nyenyefatsa kapa ho fana ka melaetsa e kopaneng ho ngoana le ho batsoali. Ha ho na pheko bakeng sa ho se sebetse hantle ka kalafo mme kalafo e tlameha ho tswella pele bophelo bohle (Jones, 2000). Bana ba nang le bothata ba lefu la EF ba ka fihlela katleho le ho qoba ho kena mathateng ha feela ba ts'ehelitsoe ke motho e mong, motsoali, mosuoe, motataisi kapa motsoalle ho sebetsa e le "surrogate frontal lobe" ho ba tataisa le ho ba boloka ba le tseleng . Patlisiso e shebaneng le moo matšoao a bonoang a amanang le bofokoli bo ikhethang ba EF e na le litlamorao tse kholo bakeng sa ho kenella hoa kelello molemong oa psychopharmacological sebakeng sena ka ho hlakisa likarolo tse ka tlase tsa neural le litsela tse tsamaisang matšoao a lefu lena (O'Grada le Dinan, 2007).

References