子どもの発達と発達障害 - myclinic.ne.jp

1 1 20 11 30 , MD, PhD (gross motor development: ) (PT) (fine motor development: : ) (OT) (ST) (SST) 0 1 3 (kg)12-1350-70 (cm)90150-180 (g)13405033309 759251140 4 6 10 18 24 36 4 6 10 18 24 2 36 3 Refer to Dekaban A (1970): Neurology of early childhood. 2 1997 1 ( )

2 MBD HFPDD ADHD --- 5 ( ) HFPDD I1. 2. 3. HFPDD II 4 1. PDD HFPDD 2. 3.

3 4. ADHD 1. 2. / 3. ADHD 3 or Proposition for pathophysiology of ADHD and chronic tic disorder ADHD children is related to neuronal hyperactivity in the cortex which may be due to an imbalance between cortical excitation and inhibition. (Rapin 1982, Oades 1987, Voeller1991) Since ADHD and chronic tic disorder are disorders of disinhibition, it is reasonable to suggest that genetic defects and dysfunction in GABA pathways, which is an inhibitory neurotransmitter, could be involved. (Comings 2001) Abnormal SEP Findings of TD N=18 No.

4 Of patients with any abnormal findings; 9 Giant SEP; 73y11m male with TDLMNS RMNSPeak-to-peak amplitude of N20-P25 LMNSRMNS* P< , ** P< N20-P25 PPA TD TD TD GABAB dysfunction Deficient motor inhibition within the sensorimotor circuit VPA cf. ADHD GABAA dysfunction Inhibitory deficit within the mortorcortex CBZMoll GH et al. Ann Neurol 2001 (L-dopa VPA 3 5 5 2006 7 27 17 5 18 3 5 5 DSM-IV ADHD PDD 28 3 56 7)

5 9 18 n=278 or 18 n=278 3 664 644 135 664 39 050100150200250300H17 H18 H19 17 18 19 010203040506070H17 H18 H19 05101520H17 H18 H19 39 2273412 39 3 0510152025 39 12 23 GABA GABA Mirror Neuron System (MNS)

6 In primates, ventral premotor and rostalinferior parietal neurons fire during the execution of hand and mouth. Some cells (called mirror neurons) also fire when hand and mouth actions are just observed. Mirror neurons provide a simple neural mechanism for understanding the action of others.