danarTi 1

miRebulia “klinikuri praqtikis erovnuli damtkicebulia saqarTvelos Sromis,

rekomendaciebis (gaidlainebi) da janmrTelobisa da socialuri dacvis
daavadebaTa marTvis saxelmwifo ministris 2010 wlis 11 oqtombris
standartebis (protokolebi) SemuSavebis, # 332/o brZanebiT
Sefasebisa da danergvis erovnuli sabWos"
2009 wlis 30 dekembris #2 sxdomis
gadawyvetilebis Sesabamisad

yuradRebis deficitisa da
hiperaqtivobis sindromis
marTva saskolo asakis
bavSvebsa da mozrdilebSi
pirveladi jandacvis doneze

klinikuri praqtikis erovnuli rekomendacia

(gaidlaini)

1
 yuradRebis deficitisa da hiperaqtivobis
sindromis marTva saskolo asakis bavSvebsa da
mozrdilebSi pirveladi jandacvis doneze

1. ganmarteba, sinonimebi, klasifikacia da

terminologia
ganmarteba:
ADHD warmoadgens heterogenul qceviT sindroms, mimdinares
yuradRebis koncentrirebis deficitiT, hiperaqtivobiTa da
impulsurobiT.
yuradRebis deficiti, hiperaqtivobis sindromi (ADHD)
1 2
warmoadgens neiro-bihevialuri ganviTarebis aSlilobas . ADHD
identificirebulia, rogorc `uyuradRebobis da hiperaqtivoba-
impulsurobis mdgradi magaliTi, romelic ufro xSirad mJRavndeba
da ufro mZimea, vidre Cveulebriv SeiniSneba individebSi, romlebic
imyofebian ganviTarebis analogiur doneze~3.
yuradRebis deficitis/hiperaqtivobis sindromi da
hirperkinetikuri aSlilobis ganmarteba (ICD-10) efuZneba
impulsurobis, hiperaqtivobis da yuradRebis koncentrirebis
deficitis Zalian maRali doniT gamovlinebas. am simptomebis
konstatacia SesaZlebelia bavSvis qcevaze dakvirvebiT: naadrevi
da gauazrebel moqmedebebi impulsurobaze miuTiTebs, mousvenari
da xSirad cvalebadi moZraoba hiperaqtivobaze, xolo moqmedebebis
araorganizebuloba, xangrZlivi da guldasmiTi Zalisxmevis
uunaroba - yuradRebis koncentrirebis deficitze.
ADHD ganixileba, rogorc bavSvobis asakisaTvis damaxasiaTebeli
diagnozi, Tumca simptomebi SeiZleba mozrdil asakSic gagrZeldes4.
arsebuli SefasebebiT amerikel mozrdilTa 4,7 procents
aReniSneba ADHD 5 . ADHD-s diagnozi ori - oTxjer ufro xSirad
ismeba biWebSi, vidre gogonebSi 6 , 7 , Tumca rigi mkvlevarebis azriT,
es gansxvaveba SesaZlebelia aixsnas maswavleblebis subieqturi
damokidebulebiT (mikerZoebiT)8.

klasifikacia
ADHD warmoadgens ganviTarebis darRvevas, romelis drosac
garkveuli damaxasiaTebeli niSnebi, rogoricaa hiperaqtiuroba,
yuradRebis deficiti iwvevs CamorCenas ganviTarebaSi 9 . Tavis tvinis
Subliswina qerqis magnituri rezonansis gamosaxulebiT
ganviTarebis es Seferxeba ZiriTadad vlindeba 3-dan 5 wlis

2
asakSi 10 . varaudoben, rom swored es Seferxebebi iwvevs
janmrTelobis gauaresebas 11 . ADHD aseve klasificirebulia
rogorc qcevis aSliloba. Tumca, ADHD-is diagnozi, ar
gulisxmobs nevrologiur daavadebas.
ADHD klasificirebulia rogorc qcevis dezorganizaciuli
aSliloba, qcevis aSlilobasa da antisocialur aSlilobasTan
erTad12.
ADHD-s sami qvetipi gaaCnia:
1. upiratesad hiperaqtiur-impulsuri;
2. upiratesad yuradRebis deficitiT mimdinare;
3. kombinirebuli - hiperaqtiur-impulsuri da uyuradReboba.

bavSvTa asakSi arsebuli ADHD

yuradRebis deficiti, hiperaqtivobis sindromi (ADHD) warmoadgens
gavrcelebul bavSvTa daavadebas, romlis mkurnaloba
SesaZlebelia. ADHD-s SeuZlia tvinis im garkveuli ubnebis
dazianeba, romlebic gvaZleven problemebis gadawyvetis, winaswari
dagegmvis, sxvaTa qmedebis gagebis da zraxvebis kontrolis
13
saSualebas .

mozrdilTa ADHD.
dadgenilia, rom aSS-Si daaxloebiT 8 milion mozrdils aqvs
ADHD 14 . ADHD-s mqone ganukurnebel mozrdilebs xSirad aqvT
cxovrebis qaoturi stili, SeiZleba Candnen araorganizebulebad
da miiRon daniSnulebis gareSe wamlebi an alkoholi, raTa
gamovidnen mdgomareobidan 15 . maT xSirad aqvT iseTi asocirebuli
fsiqiatriuli Tanmxlebi daavadebebi, rogoricaa depresia, SfoT-
viTi aSliloba, bipolaruli aSliloba, narkotikebis borotad
gamoyeneba an swavlis dros aTvisebis sirTuleebi15. ADHD-s
diagnozis dasma SeiZleba daexmaros mozrdilebs daakvirdnen, Cawv-
dnen Tavis qcevas da xels uwyobs pacientebs gaxdnen ufro
gaTviTcnobierebulni da eZebon gamosavali sirTuleebis daZlevis
da mkurnalobis strategiebSi14. arsebobs garkveuli uTanxmoeba
zogierT eqsperts Soris, gvxvdeba Tu ara ADHD mozrdil asakSi.
1978 wels mozrdilebSi misi arsebobis aRmoCenis Semdeg, is
amJamadac ar aris erTmniSvnelovnad dakavSirebuli bavSvobaSi
arsebul ADHD-sTan15. im winaaRmdegobebs Soris, romlebsac
klinicistebi awydebian mozrdilebTan ADHD-s diagnozis
dadgenisas, aris ganviTarebasTan Seusabamo diagnostikuri
kriteriumebi, asakTan dakavSirebuli cvlilebebi, Tanmxlebi

3
 daavadebebi da imis SesaZlebloba, rom maRal inteleqts an
situaciur faqtorebs SeuZliaT daCrdilon ADHD-s simptomebi.

gaidlainSi gamoyenebuli Semoklebebi

yuradRebis deficiti/ hiperaqtiuri

ADHD
– sindromi.
daavadebaTa da maTTan dakavSirebuli
– janmrTelobis problemebis saerTaSoriso
ICD 10
statistikuri klasifikaciis meaTe
gadaxedva.
fsiqiuri darRvevebis diagnostikuri da
DSM-IV – statistikuri saxelmZRvanelos meoTxe
gamocema.
FDA – wamlebis federaluri sammarTvelo
_ bavSvTa da mozardTa fsiqiatriis amerikis
AACAP
akademia.
AAP _ amerikis pediatriis akademia.

2. epidemiologia
ADHD (yuradRebis deficiti, hiperaqtivobis sindromi DSM-IV-is
gansazRvrebiT, hiperkinetikuli aSliloba ICD-10-is gansazRvrebiT)
farTodaa gavrcelebuli. gaerTianebul samefoSi 10.438 bavSvze (5
wlidan 15 wlamde asakis) Catarebulma kvlevam daadgina, rom
biWebis 3,62% da gogonebis 0,85%-s aqvs ADHD16.
aSS-Si Catarebuli erT-erTi kvlevis mixedviT dafiqsirda mcire,
Tumca mniSvnelovani cvlilebebi daavadebis gavrcelebis doneSi
afroamerikelTa (5,65%), laTinoamerikelTa (3,06%) da TeTrkanianTa
(4,33%) Soris 17 , Tumca, aseTi gansxvavebebi SeiZleba aixsnas
sxvadasxvanairi kulturuli tolerantobiT ADHD-is simptomebis
mimarT.
sistemuri metaregresiuli analizis Sedegebis mixedviT 18 ADHD-s
gavrcelebis variabelobis ZiriTadi ganmapirobebelia gamoyenebuli
meTodologia, kerZod, simptomebis Sefasebis meTodebisa da
gansazRvrebebis araidenturoba.

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ADHD mozrdilebs Soris
ADHD-s gavrceleba iklebs asakTan erTad. bavSvobaSi ADHD-is
diagnozis mqone individebTa monacemebis xangrZlivma
bolodroindelma kvlevebma aCvena, rom 25 wlis asakSi mxolod 15%-
s unarCundeba sruli ADHD diagnozi, magram, gacilebiT didi
nawili (65%) akmayofilebs an ADHD-s anda ADHD-s nawilobriv
remisiis kriteriumebs, rac SemTxvevaTa umravlesobaSi miuTiTebs
klinikuri gaumjobesebis fonze garkveuli simptomebis
mdgradobaze 19 . Tu mivusadagebT am cifrebs daavadebis gavrcelebis
diapazons 4-8%, romelic zogadad SeiniSneba bavSvebSi,
mosalodnelia, rom mozrdilTa 0,6-1,2%-Si 25 wlis asakSi
SenarCunebuli iqneba ADHD-s sruli diagnozi. ufro didia ADHD-s
nawilobrivi remisiis SenarCunebis procenti (2-4%). es Seesabameba
mozrdilTa populaciaSi Catarebul mosaxleobis kvlevas, romelic
afasebs ADHD-s gavrcelebas mozrdilebSi 3-dan 4%-mde20.

prognozi
bavSvebs, romlebsac daesvaT ADHD-s diagnozi, miuxedavad
mkurnalobisa. aqvT seriozuli sirTuleebi mozardobis asakSi 21 .
aSS-Si, ADHD-s mqone bavSvTa 37% ar Rebulobs saSualo skolis
diploms, miuxedavad imisa, rom bevri maTgani sargeblobs
damatebiTi saganmanaTleblo momsaxurebiT9, ADHD-s mqone
moswavleTa TiTqmis naxevari ver amTavrebs saSualo skolas22. aseve,
aSS-Si, ADHD-s mqone individTa 5%-ze naklebi Rebulobs kolejis
(umaRlesi saswavlo dawesebulebis) diploms, rac sakmaod dabali
maCvenebelia ZiriTadi mosaxleobis 28%-Tan SedarebiT 23 . bavSvobaSi
ADHD-s mqone adamianebi arian arasasurveli sayofacxovrebo
SemTxvevebis maRali riskis qveS maSin, roca xdebian Tineijerebi. am
SemTxvevebs Sorisaa avtokatastrofebi, travmebi, maRali
samedicino xarjebi, wamaldamokidebuleba, adreuli seqsualuri
aqtiuroba da mozard asakSi orsulobis ufro maRali riski1.
ADHD-is diagnostikuri kriteriumebis mqone bavSvebis wili
mcirdeba daaxloebiT 50%-iT diagnozis dasmidan 3 wlis Semdeg. es
xdeba miuxedavad imisa, Tu ra mkurnaloba aris gamoyenebuli da
aseve xdeba ADHD-s mqone aranamkurnaleb bavSvebSic 24 , 25 , 26 .
daavadebul pirebTan, maT momwifebasTan erTad, viTardeba
sirTulis daZlevis meqanizmebi da xdeba maTi adrindeli ADHD-is
kompensacia15.

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3. etiopaTogenezi
etiologia
ADHD-s diagnozi ar gulisxmobs samedicino an nevrologiur
mizezs. Tumca, fsiqosocialuri araxelsayreli faqtorebis
arsebobam an risk-faqtorebmac ar unda gamoricxos ADHD-s
diagnozi. ADHD-s etiologia moicavs mravali genetikuri da
garemo faqtoris urTierTqmedebas. ADHD ganixileba, rogorc
sxvadasxva qvetipebis mqone heterogenuri aSliloba, romelic
erToblivad moqmedi risk-faqtorebis sxvadasxva kombinaciis
Sedegia.

genetikis zegavlena
ADHD-s ganviTarebisaTvis mniSvnelovania genetikuri faqtorebi.
ormagi kvlevis Sedegebi gviCvenebs, rom mosaxleobaSi arsebuli
ADHD-s sindromebis variaciis daaxloebiT 75% gamowveulia
genetikuri faqtorebiT^(memkvidreobiTobis Sefaseba 0,7-dan 0,8-mde)27.
ADHD-Si identificirebuli araa arc erTi didi efeqtis mqone geni;
ufro savaraudoa, rom masTan mcire efeqtis mqone ramodenime dnm-
is variaciaa asocirebuli (TiToeuli mcire raodenobiT zrdis
ADHD-s mimarT mgrZnobelobas).
mkvlevarebi Tvlian, rom ADHD-is SemTxvevaTa didi umravlesoba
ganpirobebulia sxvadasxva genebis kombinaciiT, romelTaganac
bevri dofaminis gadamtania. Sesaferis genebs Soris arian
dofaminis gadamtani receptori D4, dofamin beta-hidroqsilaza,
monoamin oqsilaza A, kateqolamin-meTil transferaza, serotoninis
gadatanis xelSemwyobi (SLC6A4), 5-hidroqsitriptamin 2A receptori
(5-HT2A), 5-hidroqsitriptamin 1B receptori (5-HT1B)28, DAT1 genis 10-
jer gameorebuli aleli 29 , DRD4 genis 7-jer gameorebuli aleli
da dofamin beta hidroqsilazas geni (DBH Taq1)30.
zemoT aRniSnuli CamonaTvali migvaniSnebs, rom ADHD ar imeorebs
`genetikuri daavadebebis~ tradiciul models da Sesabamisad, unda
ganxilul iqnes, rogorc genetikuri da garemo faqtorebis
kompleqsuri urTierTqmedebis Sedegi. miuxedavad imisa, rom yvela
am gens SeuZlia Tavisi roli Seasrulos, dRemde ar aris
dadasturebuli, rom romelime calkeul gens yvelaze didi
wvlili Seaqvs ADHD-s ganviTarebaSi31.

6
garemo faqtorebis zegavlena
dRemde Catarebuli ormagi kvlevebi aseve gvaCveneben, rom
hiperaqtiuri-impulsuri-uyuradRebo qcevis an ADHD-s simptomebis
variaciis daaxloebiT 9-dan 20%-mde SeiZleba mieweros garemo
(aragenetikur) faqtorebs32,33.

biologiuri faqtorebi
faqtorebis mTeli diapazoni, romelic uaryofiTad moqmedebs Tavis
tvinis ganviTarebaze perinatalur periodSi da adreul bavSvTa
asakSi, asocirebulia ADHD-s riskis gazrdasTan, anu yuradRebis
deficitis aSlilobasTan hiperaqtivobis gareSe. es faqtorebi
moicavs dedis mier orsulobis dros sigaretis mowevas 34 ,
alkoholis moxmarebas 35 da heroinis moxmarebas 36 , dabadebisas
nayofis Zalian mcire wonas, 37 , nayofis hipoqsias, Tavis tvinis
dazianebas, toqsinebis zemoqmedebas, rogoricaa tyvia da cinki 38 .
risk-faqtorebi ar moqmedeben izolirebulad, aramed
urTierTqmedeben erTi meoresTan.
dakvirvebiT dadgina, rom ADHD-is pacientebs Tavis tkivilebis
sixSire saSualoze ufro maRalia 39 , Tumca, amJamindeli faqtebi ar
miuTiTeben imaze, rom dakvirvebis qveS myof pacientebSi Tavis
tkivilebi SeiZleba iyos ADHD-s mizezi 40.
arsebobs ADHD-s simptomebis warmoSobis gazrdili riski:
epilefsiis dros, genetikuri daavadebebis dros, rogoricaa 1
tipis neirofibromatozi 41 da iseTi sindromebi, rogoricaa
angelmanis, prader-vilis, smiT magenisis, myife X-qromosomis sind-
romi 42 . meoradi ADHD SeiZleba gamoiwvios Tavis tvinis travmulma
dazianebam43.

dietasTan dakavSirebuli faqtorebi

zogierTi bavSvis SemTxvevaSi eWvoben, rom dieta TamaSobs rols
ADHD-s mravali qceviTi da SemecnebiTi simptomebis ganviTarebaSi.
yuradReba gamaxvilebulia sakveb danamatebze, sisxlSi Saqris
regulirebaze, kvebiT alergiaze, aseve vitaminebis, mineralebis da
cximis mJavis deficitzeError! Bookmark not defined..
dietasTan dakavSirebuli faqtorebis zegavlenam ADHD-ze farTo
sajaro interesi gamoiwvia: sakvebi danamatebi, Saqari, saRebavi
nivTierebebi da `E~ ricxvebi xSirad ganixileboda, rogorc ADHD-s
mizezi. xSirad profesiuli rCevis gareSec ki, farTod gamoiyeneba
dietebi kvebiTi danamatebiT.
epidemiologiuri kvlevebi migvaniSnebs dietisas gamoyenebul
danamatebsa da konservantebs da hiperaqtivobis dones Soris

7
arsebul kavSirze 44 , monacemebi sarwmuno ar aris, magram ADHD-s
mqone bavSvebis mcire nawili amJRavnebs idiosinkreziul reaqcias
zogierT naturalur sakveb produqtze da/an xelovnur danamatebze,
da SeiZleba maTTvis daxmarebis gaweva gamoyenebuli
konservantebisa da danamatebis gamoricxvis xarjze.

fsiqosocialuri faqtori
kvlevebiT miRebuli ar aris damajerebeli mtkicebulebebi, rom
mxolod socialurma faqtorebma SeiZleba gamoiwvion ADHD-i9. rigi
kvlevebiT dasturdeba, rom momvlelebis urTierTobas bavSvebTan
SeuZlia Zlieri moqmedeba moaxdinos yuradRebis da
TviTregulirebis SesaZleblobebze, Tumca monacemebi calsaxa ar
aris.Error! Bookmark not defined.,45.
darRveuli da Seusabamo urTierTobebi ufro Cveulia ADHD-s
mqone axalgazrduli ojaxebisaTvis 46 . Seusabamo ojaxuri
urTierTobebi, SeiZleba, iyos amave dros ADHD-s mqone bavSvTan
cxovrebis Sedegic. damkvidrebuli ADHD-is dros mkacri aRzrdis
wesis momcveli urTierTobebi warmoadgens qcevasTan
dakavSirebuli problemebis ganviTarebis risk-faqtors. mSoblebis
mimarT mtruli ganwyobileba da kriticizmi SeiZleba Semcirdes im
bavSvebSi, romelTa ADHD-s simptomebi warmatebulad iqna
gankurnebuli stimulatorebis meSveobiT 47 . mSoblebs SeiZleba
Tavadve hqondeT daudgeneli da arakontrolirebuli ADHD, rac
araxelsayrelad imoqmedebs maT SesaZleblobaze gauwion daxmareba
qcevis aSlilobis mqone bavSvs.

nevrologiuri Teoriis nairsaxeoba

am Teoriis momxreebi amtkiceben, rom atipuri nevrologiuri
ganviTareba aris gansxvaveba, romelic tolerantulad unda iqnes
miRebuli da romelsac pativi unda eces iseve, rogorc sxva
adamianur gansxvavebulobas.

dabali aqtivaciis Teoria

dabali aqtivaciis Teoriis mixedviT, ADHD-s mqone adamianebi
iyeneben TviTstimulacias da cdiloben iyvnen gadametebulad
aqtiurebi, raTa aamaRlon Tavisi aranormalurad dabali
48
aqtivaciis mdgomareoba . am Teoriis mixedviT isini, visac ADHD
aqvT, ver axerxeben TviTSekavebas da maTi yuradReba SeiZleba
mipyrobil iqnas mxolod garemo stimulatorebze, rac Tavis mxriv
gamoixateba sabolood yuradRebis gamaxvilebis SesaZleblobis
darRvevaSi da hiperaqtiuri qcevis momatebaSi.

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garemodan miRebuli sakmarisi stimulirebis gareSe, ADHD-s mqone
bavSvi TviTon qmnis amas bodialis, mousvenari moZraobis,
laparakis da a.S. xarjze. es Teoria aseve xsnis, Tu ratom aqvT
stimulator medikamentebs esoden maRali samkurnalo efeqti da
Terapiuli dozebSi SeuZliaT gamoimuSaon damSvidebis efeqti
ADHD-s mqone bavSvebSi. es Teoria mWidro kavSirSia mecnierul
monacemebTan, rom ADHD dakavSirebulia neiroqimiuri dofaminis
anomaliebTan48.

paTfiziologia
ADHD-s paTfiziologia naTeli ar aris da arsebobs ramodenime
urTierTgamomricxavi Teoria 49 . ADHD-s mqone bavSvebis erT-erTma
kvlevam aCvena Tavis tvinis moculobis, zogadi Semcireba, magram is
proporciulia marcxena mxaris Subliswina Tavis tvinis qerqis
moculobis didi Semcirebisa. es aRmoCenebi gvimtkicebs, rom ADHD-
s ZiriTadi Taviseburebebi (uyuradReboba, hiperaqtivoba,
impulsuroba) SeiZleba gamoxataven frontaluri Sublis
disfunqcias, magram Tavis tvinis sxva ubnebi, gansakuTrebiT
naTxemi, aseve Cabmulia amaSi 50 . ADHD-s neirovizualuri kvlevebi
yovelTvis ar iZlevian Tanmimdevrul Sedegs, da 2008 wlisTvis
isini gamoiyeneboda mxolod kvlevisTvis da ara diagnostikuri
mizniT51.
erT-erT kvlevaSi, dawyebiTi skolis asakis ADHD_s pacientebSi,
Tavis tvinis centraluri struqturis ganviTarebis Seferxeba
saSualod sami wlis ganmavlobaSi xdeboda. Seferxeba yvelaze
mniSvnelovnad iyo gamoxatuli Tavis tvinis Sublis qerqsa da
safeTqlis nawilSi, romelic rogorc cnobilia, agebs pasuxs
azrovnebis kontrolsa da fokusirebaze. sapirispirod, ADHD-s
mqone pacientebSi Tavis tvinis qerqis “moZraobis zonis” ufro
swrafi momwifeba SeiniSneboda, vidre Cveulebrivad xdeba, ris gamo
SeiZleba vivaraudoT, rom qcevis kontrolis ufro neli
ganviTareba, aseve, motorikis ufro swrafi ganviTareba SeiZleba
iwvevdes met mousvenrobas - hiperaqtivobas, rac damaxasiaTebelia
ADHD-sTvis52.
imave laboratoriaSi manamde iyo aRmoCenili dofamin D4 receptori
genis `7-jer ganmeorebuli~ variantis monawileoba, romelic pasuxs
agebs ADHD-s genetikuri riskebis daaxloebiT 30%-ze, Tavis tvinis
qerqis marjvena nawilis uCveulo Seviwrovebaze, Tumca, ADHD-s
mqone pacientebSi aRmoCenili genis sxva variantebis sapirispirod,
am bavSvebSi aTi wlis ganmavlobaSi es nawili normalizdeboda,
rac emTxveoda klinikur gaumjobesebas53.

9
 amasTan erTad, gama-tomografiuli skanirebiT naCvenebia ADHD-s
mqone adamianebSi sisxlis Senelebuli mimoqceva (rac mianiSnebs
dabal nervul aqtivobaze) 54 da dofaminis koncentraciis
mniSvnelovani momateba striatumSi, romelic pasuxs agebs winaswar
dagegmvaze55,56.

4. klinikuri simptomatika
simptomebi
ADHD-isTvis damaxasiaTebelia Semdegi simptomebi:
 uyuradReboba
 hiperaqtivoba
 impulsuroba
uyuradReboba, hiperaqtivoba da impulsuroba warmoadgenen ADHD-s
damaxasiaTebel qceviT maneras. ADHD-s simptomebis identificireba
sakmaod rTulia imis gamo, rom saWiroa gansazRvra, Tu sad
mTavrdeba uyuradRebobis, hiperaqtivobisa da impulsurobis
normaluri done da iwyeba klinikurad mniSvnelovani done,
romelic saWiroebs intervencias.

ADHD-s qvetipebi
ADHD-s sami qvetipi gaaCnia:
1. upiratesad hiperaqtiur-impulsuri;
 simptomTa umetesoba (eqvsi an meti DSM-IV kriteriumebidan)
aris hiperaqtiur-impulsuri kategoriis;
 uyuradRebobis eqvsze naklebi simptomia saxeze, Tumca
garkveulwilad SeiZleba iyos ganxiluli uyuradRebobac.

2. upiratesad uyuradReboba;
 simptomTa umetesoba (eqvsi an meti DSM-IV kriteriumebidan)
aris uyuradRebobis kategoriis;
 arsebobs hiperaqtivoba-impulsurobis eqvsze naklebi simptomi,
Tumca garkveulwilad SeiZleba iyos warmodgenili
hiperaqtivoba-impulsurobac.
 am qvetipis mqone bavSvebi naklebad axerxeben Tavis moCvenebas,
aqvT sirTuleebi sxva bavSvebTan Seguebisas. isini SeiZleba
Cumad isxdnen, magram sulac ar aqceven yuradRebas imas, Tu

10
 ras akeTeben. Sesabamisad, aseT bavSvebs SeiZleba arc ki
mieqces yuradReba, da mSoblebma da maswavleblebma SeiZleba
verc ki SeamCnion ADHD-s simptomebi.

3. kombinirebuli hiperaqtiur-impulsuri da uyuradReboba.

 saxezea rogorc uyuradRebobis aseve hiperaqtivoba-
impulsurobis eqvsi an meti simptomi (DSM-IV kriteriumebidan);
 bavSvTa umravlesobas ADHD-s kombinirebuli tipi gaaCnia.

qvemoT CamoTvlilia uyuradRebobisa da hiperaqtivoba-

impulsurobis damaxasiaTebeli simptomebi:
1. upiratesad uyuradRebobis:
 yuradRebis advilad gadatana, detalebis gamotoveba, sagnebis
daviwyeba, xSiri gadarTva erTi aqtiurobidan meoreze.
 erT rameze fokusirebis (koncentrirebis) siZneleebi.
 raime amocanis gadawyvetisas sul raRac wuTebSi mowyenas,
maSinac ki, rodesac isini raRacas gasarTobs akeTeben.
 sirTuleebs raime amocanis organizebasa da dasrulebaze
yuradRebis fokusirebisas da raime axlis swavlebisas.
 problemebs saSinao davalebebis Sesrulebisas an Cabarebisas,
im sagnebis (magaliTad, fanqrebi, saTamaSoebi, davalebebi)
xSir dakargvas, romlebic saWiroa amocanis an saqmianobis
dasrulebisaTvis.
 saubris dros mosmenis naklebobas (TiTqos ar usmenen
mosaubres).
 ocnebas, advilad dabnevas da nel moZraobas.
 sirTuleebs informaciis ise swrafad da akuratulad
damuSavebisas, rogorc amas sxvebi axerxeben.
 sirTuleebs instruqciebis midevnebisas.
2. upiratesad hiperaqtiur-impulsurobis;
 mousvenrad moZraobas da trials Tavis skamze.
 saubars gaCerebis gareSe.
 swraf moZraobas aqeT-iqiT, mxedvelobis areSi myofi yvelas
da yvelafris Sexebas da TamaSs.

11
  problemebs adgilze jdomasTan dakavSirebiT sadilis dros,
skolaSi an moyolis dros.
 mudmivad moZraobaSi yofnas.
sirTuleebs raime amocanisa an saqmianobis wynarad keTe-
bisTvis.
am qvetipSi, zemoxsenebulis garda, upiratesad impulsuri
xasiaTis simptomebs miakuTvneben:
 arian Zalian mouTmenelni.
 wamoroSaven Seusabamo komentarebs, amJRavneben Tavis emociebs
yovelgvari moridebis gareSe da moqmedeben mosalodneli
Sedegis gaTvaliswinebis gareSe.
 aqvT sirTuleebi sasurveli sagnebis molodinisas an Tama-
Sisas Tavisi rigis lodinisas.
adamianTa umetesoba amJRavnebs xolme zogierT aseT qcevas, magram
ara im doneze, rodesac amgvari qceva mniSvnelovnad xels uSlis
adamianTa saqmianobas, urTierTobas an swavlas. ZiriTadi
darRvevebi Sesabamisi da erTnairia, sxvadasxva kulturul
konteqstSic ki.
simptomebi SeiZleba arsebobdes mozrdil asakSic ADHD-s
diagnozis mqone bavSvTa naxevarze metSi. amisi dadgena rTulia,
vinaidan mozrdilTaTvis ar arsebobs ADHD-s aRiarebuli
sadiagnozo kriteriumebi.

ADHD-s simptomebi da Tanmxlebi aSlilobebi

ADHD-s SeiZleba Tan axldes sxva aSlilobebs, rogoricaa SfoTva
an depresia. aseT kombinaciebs SeuZliaT Zlier gaarTulon
diagnozis dasma da mkurnaloba. akademiurma da kerZo praqtikis
kvlevebma daadgines, rom ADHD-s dros bavSvebSi asakis matebasTan
erTad matulobs depresiis SemTxvevebi, Tanac igi gogonebSi ufro
maRali siCqariT izrdeba, vidre biWebSi, da gansxvavdeba
gavrcelebaSi ADHD-s qvetipebis mixedviT. rodesac xasiaTis
aSliloba arTulebs ADHD-s, ufro mizanSewonili iqneboda
Tavdapirvelad xasiaTis aSlilobis mkurnaloba, magram ADHD-s
mqone bavSvebis mSoblebs xSirad surT, rom Tavidan jer ADHD
iyos gankurnebuli, vinaidan mkurnalobis Sedegi ufro swrafia.
uyuradReboba da `hiperaqtiuri~ qceva sulac araa erTaderTi
problema ADHD-is mqone bavSvebSi. mravali Tanaarsebuli daavadeba
moiTxovs mkurnalobis sxva kursis Catarebas da maTTvis diagnozi
cal-calke unda daisvas, imis nacvlad, rom yvela erTbaSad

12
dajgufebuli iyos ADHD-is diagnozis qveS. qvemoT CamoTvlilia
uxSiresi asocirebuli daavadebebi:
 opoziciur-devianturi qceviTi aSliloba - negatiuri da mavne
qcevebis gamovlineba socialuri normebis darRvevis gareSe
(35%);
 qceviTi aSliloba (26%), romelic xasiaTdeba antisocialuri
qceviT, rogoricaa jiutoba, agresia, gaRizianebis xSiri
afeTqebebi, orpiroba, tyuilebis Tqma an qurdoba;
 yuradRebis pirveladi aSliloba, romelic xasiaTdeba susti
yuradRebiT da koncentraciiT, da aseve fxizlad yofnis
sirTuleebi. aseTi bavSvebi ixrebian mousvenrad moZraobisken,
xSirad amTqnareben da izmorebian, cdiloben bevri imoZraon,
raTa aqtiurebi da fxizlebi gamoCndnen.
 xasiaTis aSliloba _ kombinirebuli qvetipis diagnozis mqone
biWebi ufro savaraudod ganicdian zians xasiaTis
aSlilobisagan;
 bipolaruli aSliloba - ADHD-s mqone bavSvebis aranakleb
25% aqvT bipolaruli aSliloba. aseTi kombinaciis mqone
bavSvebma SeiZleba gamoamJRavnon meti agresia da qcevasTan
dakavSirebuli problemebi, vidre im bavSvebma, romlebsac
mxolod ADHD-i aqvT;
 SfoTviTi aSliloba, romelic, rogorc aRmoCnda, ufro
gavrcelebulia gogonebSi, romlebsac daesva ADHD-s
uyuradRebobis qvetipis diagnozi;
 obsesiur-kompulsuri aSliloba - varaudoben, rom obsesiur-
kompulsuri aSliloba iziarebs genetikur komponents ADHD-
sTan da mis mraval maxasiaTebels.

ADHD-Tan asocirebuli gavrcelebuli problemebi:

xSirad ADHD-is problemebi bavSvebSi warmodgenilia
ganviTarebasTan dakavSirebul sxva sisustesTan, naklTan da/an
fsiqikur problemebTan erTad. arsebobs sakmaod araspecifikuri,
zogadi problemebi, romlebic Zalian xSiria yuradRebis
deficitisagan gamowveuli hiperaqtivobis aSlilobis dros da
romlebic arasworadac ki SeiZleba iyos gamoyenebuli, rogorc
diagnozis dasmis safuZveli (ix. cxrili 1).
amdagvar problemebs sWirdebaT amocnoba da zogjer Careva, magram
miuxedavad amisa, aseTi problemebi TavisTavad mainc ar
warmoadgenen diagnozis safuZvels, radganac isini SeiZleba

13
gamowveulni iyvnen sxva mravali mizeziT. amasTanave, mozardebma,
iseve rogorc zrdasrulma adamianebma, SeiZleba gamoamJRavnon sxva
asocirebuli problemebi, magaliTad rogoricaa sakuTari Tavis
daSaveba, sagzao avariebisadmi midrekileba, nivTierebebis an
wamlebis aramiznobrivad miReba, danaSaulebrioba, aforiaqebuli,
mSfoTvare mdgomareoba da cudi akademiuri moswreba da swavla.
TavisTavad zemoT CamoTvlili problemebi ar warmoadgens
diagnozis safuZvels da SeiZleba gamowveuli iyos ADHD-iT an
romelime sxva mizeziT.

cxrili 1. ADHD-Tan asocirebuli gavrcelebuli problemebi.

urCi, aradamyoli qceva. Uuneblie tikebi

cudi, mSfoTvare Zili
agresia
Wirveuli xasiaTis
gamovlinebebi, isterikebi
wera_ kiTxvis swavlaSi
problemebi da swavlasTan
dakavSirebuli sxva sirTuleebi
Gganwyobilebis uecari
cvalebadoba
TanatolebTan Seuguebloba,
konfliqti
mouxerxebloba
asakTan Seuferebeli,
CamorCenili metyveleba.

asakis matebiT ganpirobebuli cvlilebebi.

ADHD-sTan dakavSirebuli problemebi sxvadasxva asakSi sxvadasxva
formiT iCens Tavs. cvlilebebi qcevaSi aRiniSneba individis
Camoyalibebis, simwifis etapebis miRwevis paralelurad da imis
mixedviT, Tu ra moTxovnebs ayenebs gare samyaro individis mimarT57.
hiperaqtivoba skolamdeli asakis bavSvSi SeiZleba vlindebodes
misi moqmedebebis ganuwyvetel da momTxovn ukiduresobebSi; skolis
periodSi aseTi bavSvi SeiZleba aRmoCndes gadametebulad moZravi
iseT situaciaSi, sadac, wesiT, simSvide da mSvidi moqmedebaa ufro
mosalodneli, Tumca aseTi qceva SeiZleba ar aRiniSnebodes
sistematurad, yovelTvis erTnairi aRznebadobiT ar vlindebodes
msgavs situaciebSi. mozardobis periodSi hiperaqtivoba SeiZleba
iyos gamoxatuli ara mTeli sxeulis moZraobiT, aramed raRac
mousvenari saqcieliT, cqmutviT, wrialiT. ukve zrdasrulobis
asakSi ki es aSliloba SeiZleba gamoixatos mudmivi Sinagani
mousvenrobis, foriaqis mZafri SegrZnebiT. Aaseve SeiZleba Tavad
yuradRebis deficitis zRvarmac daiwios da asakis matebasTan
erTad koncentraciis unaris xangrZlivobac gaizardos. Tumca,

14
 aseTi koncentraciis unari mainc CamorCeba am aSlilobisgan
Tavisufali adamianebis koncentraciis unars da mainc rCeba im
zRvars miRma, romelic saWiroa adamianis yoveldRiurobaSi
garkveuli warmatebebis misaRwevad.

5. daavadebis diagnozi
klinikuri manifestacia
Cveulebriv, bavSvi ADHD ojaxis eqimTan xvdeba maswavleblis an
mSoblebis moTxovniT, mas Semdeg, rac ufrosebi uZlurni xdebian
gaakontrolon da marTon bavSvis qceva. diagnozis dasasmelad
aucilebelia srulyofili informaciis mopoveba bavSvis
arastandartuli qcevis Sesaxeb ara mxolod ojaxis wevrebisagan,
aramed sxva mozrdilebisganac, romlebic axlos arian bavSvTan (C).
informaciis Sekrebis Sesaxeb AAP da AACAP –s rekomendaciebi
58 59
mocemulia me-2 cxrilSi , . diagnozis dasasmelad informaciis
Segrovebis Semdeg aucilebelia bavSvze dakvirveba da sruli
fizikuri gamokvleva.

cxrili 2 ADHD-ze saeWvo bavSvis gamokvleva (AAP-isa da AACAP –

is kombinirebuli rekomendaciebi) 58,59.
rekomendacia 1
pirveladi jandacvis eqimma unda daiwyos gamokvleva ADHD-ze 6-dan
12 wlamde asakis im bavSvebTan, romelTac aReniSnebaT
hiperaqtiuloba, impulsuroba, dabali akademiuri moswreba an
qceviTi problemebi.
sawyisi Sefaseba unda moicavdes:
 standartuli anamnezi da fizikuri gamokvleva, AACAP-is
rekomendaciiT bavSvis ganviTarebis istoriis Sefaseba, smenis,
mxedvelobis, swavlis problemis, fsiqiatriuli daavadebisa
da ADHD-s ojaxuri istoriis gamokvleva;
 nevrologiuri gasinjva;
 ojaxis Sefaseba – AACAP-is rekomendaciiT ojaxuri stres-
faqtorebisa da ojaxis mfarvelobiTi rolis Sefaseba;
 skolis Sefaseba (ix. rekomendacia 4).

rekomendacia 2
 ADHD-is diagnozis dasasmelad aucilebelia, rom
simptomatika akmayofilebdes DSM-IV kriteriumebs.

15
rekomendacia 3
ADHD-s Sesafaseblad aucilebelia piradad mSolebis an
momvlelis mier ADHD-s ZiriTad simptomebis calsaxad
dadastureba sxvadasxva garemoSi/adgilebSi, simptomebis
aRmocenebis asaki, simptomebis xangrZlivobas da funqciuri
CamorCenis xarisxis aRwera.
rekomendacia 4
ADHD-s Sesafaseblad aucilebelia skolis maswavleblis
(damrigeblis an aRmzrdelis) mier ADHD-s ZiriTad simptomebis
calsaxad dadastureba, simptomebis xangrZlivobisa da funqciuri
CamorCenis xarisxis aRwera. eqimma yuradRebiT unda Seiswavlos
bavSvis skolis maswavleblis an skolis sxva profesionalis mier
micemuli daxasiaTeba.
rekomendacia 5
ADHD-ze saeWvo bavSvis gamokvleva moicavs Tanmxlebi
mdgomareobebis Sefasebas, rogoricaa – swavlis da metyvelebis
problemebi, SfoTva, depresia da a.S.
rekomendacia 6
diagnostikuri testebi, magaliTad, tyviis gansazRvra, TSH-is
gansazRvra, eleqtroencefalograma, rutinulad rekomendebuli ar
aris, tardeba mxolod Sesabamisi klinikuri Cvenebebis arsebobisas.

sadiagnozo kriteriumebi
ADHD-s diagnozi ismeba DSM-IV diagnostikur kriteriumebTan
(cxrili 3) Sesabamisobis SemTxvevaSi, rodesacError! Bookmark not
defined.
 bavSvs aReniSneba uyuradRebobis an hiperaqtiulobis/
impulsurobis minimum 6 simptomi 9 CamoTvlilidan;
 simptomebi aris aSkarad gamoxatuli da iwveven CamorCenas;
 grZeldeba minimum 6 Tve;
 dawyebulia 7 wlis asakamde;
 vlindeba minimum 2 sxvadasxva socialur gareomoSi (mag.
skolaSi da saxlSi, an megobrebTan urTierTobisas).

16
 cxrili N 3. ADHD-is sadiagnozo kriteriumebi DSM-IV:

I
A an B
uyuradRebobisa da hiperaqtiuloba/impulsurobis simptomebi
A
koncentraciis uunaroba – qvemoT CamoTvlilTagan eqvsi an meti
simptomi unda vlindebodes sul mcire, 6 Tvis ganmavlobaSi im
xarisxiT, rom mocemuli asakis bavSvs xels uSlides garemosTan
SeguebaSi.
1. xSirad ver axerxebs miaqcios mkafio yuradReba detalebs an
uSvebs daudevar Secdomebs skolis davalebebSi, saqmianobaSi
an sxva saxis aqtivobebSi.
2. sirTuleebi sxvadasxva davalebebis Sesrulebisas an TamaSis
dros yuradRebis garkveuli droiT daZabvisas.
3. xSirad Cans, TiTqos ar usmens masTan piradad mosaubres.
4. xSirad ar mihyveba da ar asrulebs micemul instruqciebs,
ver axerxebs skolis davalebebis damTavrebas, ver arTmevs
Tavs saojaxo an samsaxuris movaleobebs (yovelive es
gamomdinareobs winaaRmdegobrivi qcevidan, an problemebi
iqmneba instruqciis gagebaSi da mis SesrulebaSi).
5. xSirad aRiniSneba problemebi davalebebis da aqtivobebis
organizebis sakiTxSi.
6. xSirad Tavs aridebs, ar moswons, an ar surs Seasrulos
samuSao, romelic moiTxovs gonebis Zalisxmevas drois
garkveuli monakveTis ganmavlobaSi.
7. xSirad kargavs nivTebs, romlebic saWiroa ama Tu im
davalebisaTvis an aqtivobisaTvis.
8. advilad efanteba yuradReba araarsebiTi movlenebis, gare
stimulis zemoqmedebiT.
9. xSirad aris gulmaviwyi yoveldRiuri davalebebis
Sesrulebisas.
B
hiperaqtivoba-impulsuroba – qvemoT CamoTvlilTagan eqvsi an meti
simptomi unda vlindebodes sul mcire, 6 Tvis ganmavlobaSi im
xarisxiT, rom mocemuli asakis bavSvs xels uSlides garemosTan
SeguebaSi.

17
 hiperaqtivoba
1. xSirad mousvenrad amoZravebs xelebs, terfebs an cqmutavs da
wrialebs skamze.
2. xSirad dgeba adgilidan saklaso oTaxSi an romelime sxva
garemoSi, maSin, rodesac situaciidan gamomdinare, erT adgilze
mSvidad jdoma aris saWiro.
3. xSirad uadgilod da umiznod darbis an cocavs gadametebuli
aqtivobiT (mozardebsa da ufrosebSi gamoixateba mousvenrobis
grZnobiT).
4. xSirad ver axerxebs mSvidad da Cumad TamaSs, garTobas an
dasvenebas.
5. xSirad CarTulia aqtiur moqmedebebSi, adgilidan adgilze
gadadis, TiTqos Zrava amoZravebs.
6. xSirad mometebulad bevrs laparakobs.
impulsuroba
7. xSirad wamoisvris pasuxs kiTxvis daboloebis dalodebis
gareSe.
8. xSirad uWirs daelodos Tavis rigs.
9. xSirad uadgilod erTveba an awyvetinebs sxvebs ( mag. iWreba
saubarSi an TamaSSi).
II
hiperaqtiur- mpulsuri an yuradRebis koncentraciis zogierTi
simptomi, romelmac garkveuli Seferxeba gamoiwvia, bavSvs
aReniSneboda 7 wlis asakamde.
III
simptomebisagan gamowveuli SezRudvebi aRiniSneba or an met
sxvadasxva garemoSi (mag. skolaSi, saTamaSo moedanze, saxlSi da
a.S.)
IV
mniSvnelovani SezRudva/CamorCena calsaxad unda iyos gamoxatuli
socialur, saskolo an samuSao garemoSi.
V
simptomebi ar vlindeba mxolod ganviTarebis procesSi wamoWrili
aSlilobis, Sizofreniis an sxva fsiqiuri aSlilobis dros. Aam
simptomebis ukeT axsna ar SeiZleba sxva fsiqiuri aSlilobebis
gamovlinebebiT (rogoricaa mag. ganwyobilebis aSliloba, Sinagani
SfoTva da foriaqi, asociaciuri aSliloba an pirovnuli aSliloba).

18
 I suraTze mocemulia ADHD-s diagnostikis algoriTmi
suraTi 1 ADHD-s diagnostikuri algoriTmi
1
swavlis/qcevis problemebi,
saeWvo ADHD

3
2 dauyovneblivi
diax Sefaseba an/da
krizisi?
referali

ar
a

4
ADHD-s sakvanZo maxasiaTeblebis
gamokvleva DSM-IV DSM_PC kriteriumebis
gamoyenebiT:
 simptomebi;
 dasawyisi;
 xangrZlivoba;
 simptomebis arseboba sxvavdasxva
garemoSi;
 CamorCena – gauareseba
(impairment)

5
SeafaseT sxva pirveladi da komorbiduli
mdgomareobebis arseboba:
 biosamedicino problemebi;
 emociuri/fsiqiatriuli problemebi;
 ojaxis/fsiqologiuri problemebi;
 metyvelebis/enis problemebi;
 akademiuri/swavlis problemebi.

7
saWiroebs Semdgom
6 gamokvlevas, moaxdineT
savaraudoa Tu ara, rom ara koordinireba Sesabamis
ADHD pirveladi diagnozia? specialistTan. ar Sedis
mocemul gaidlainSi
diax
dia
x
8
aris romelime 9
asocirebuli
diax specialistis
komorbiduli daavadeba? konsultacia

ara

11
saWiroebs 10 ara
Semdgom ara akmayofilebs DSM-IV
gamokvlevas. ar DSM_PC kriteriumebs?
Sedis mocemul
gaidlainSi diax

12
ADHD diagnozis
formulireba

19
algoriTmis zogierTi punqtis ganmarteba grafebis nomrebis
mixedviT
1. swavlis/qcevis problemebi (saeWvo)
sakvanZo sakiTxebi:
bavSvi SesaZloa eqimTan mimarTon swavlisa da qcevis problemebis
gamo, an konkretulad ADHD-s arsebobis gamosakvlevad.
ADHD-s simptomebis intensiuroba da mravalferovneba variabeluria
bavSvis asakisa da akademiuri moswrebis mixedviT.
mSoblebis mier dafiqsirebuli SesaZlo problemebi:
 TviTneboba;
 agresia;
 mrisxanebis marTvis problema;
 impulsuroba;
 fizikurad saxifaTo aqtivobebi;
 davalebis dasrulebis problemebi;
 araorganizebuloba;
 gafantuloba, yuradRebis koncentraciis siZneleebi;
 labiluri fsiqika;
 ugunuroba;
 socialuri/emociuri umwifroba;
 gauTavebeli, “hiper” moZraobebi
maswavleblebis/skolis personalis mier dafiqsirebuli SesaZlo
problemebi:
 hiperaqtiuloba;
 dauRalavi, SfoTviTi qceva;
 uyuradReboba, davalebis ugulvelyofa, paTologiuri
yuradRebis gafantuloba;
 socialuri kavSirebis problema;
 dabali akademiuri moswreba, skolis xSiri gacdena;
 saklaso oTaxSi damangreveli qceva;
 bevri saubari, pasuxebis wamoZaxeba, wamocdena;
 cudi mosmena;
 arasruli davalebebi da davalebebis arqona;
 uwesrigo, qaosuri qceva
bavSvis/mozardis mier dafiqsirebuli SesaZlo problemebi:
 ar uyvars skola;
 ar SeuZlia axlo da xangrZlivi megobroba;

20
  konkretuli maswavleblebisa da sagnebis siZulvili;
 gadametebuli konfliqtebi mSoblebTan;
 dabali TviTrwmena, dabali sakuTari Tavis pativiscema
asakTan da ganviTarebasTan erTad ADHD-s simptomebi ganicdis
cvlilebas, magaliTad, mozardobis periodSi klebulobs
motoruli hiperaqtivoba, spontanurad umjobesdeba yuradReba da
ufro TvalsaCino xdeba antisocialuri qceva, SesaZloa problemebi
kanonTan.

2. krizisi?
ADHD-is Sefasebis dawyebamde unda ganisazRvros, xom ar aris
krizisuli situacia, romelsac dauyovneblivi Careva sWirdeba.
aRniSnuli Sefaseba unda Catardes momarTvis adgilze – ofisSi,
telefoniT, saswavlo dawesebulebaSi da a.S. krizisTan erTad
SesaZlebelia ADHD-c aRiniSnebodes, Tumca am SemTxvevaSi ADHD-s
marTva mogvianebiT unda daiwyos, krizisi saWiroebs dauyovnebliv
reagirebas. krizisis arsebobis Sesafaseblad unda daisvas Semdegi
SekiTxvebi:
 aris suicidis saSiSroeba?
 aris Zaladobis/fizikuri dazianebis saSiSroeba sxvebisaTvis?
 aris bavSvze Zaladobis saSiSroeba?
 aris skolidan garicxvis saSiSroeba?
 aris dapatimrebis/kanonTan problemebis Seqmnis saSiSroeba?

3. dauyovnebeli Sefaseba da/an referali

aRniSnuli mTlianadaa damokidebuli Sefasebis adgilze,
konkretul situaciaze da SesaZlo resursebze. mag. es SeiZleba
iyos vizitis dagegmva mentaluri janmrTelobis specialistTan,
fsiqiatrTan, socialuri samsaxuris mobilizeba, saswrafo
daxmareba da a.S. pirveladi jandacvis rgolSi unda moxdes
krizisis arsebobis Sefaseba da saWiroebis SemTxvevaSi
dauyovneblivi referali mesameul doneze (B, C, R).

4. ADHD-s sakvanZo maxasiaTeblebis gamokvleva DSM-IV

kriteriumebis gamoyenebiT:
 pirveladi simptomebis Sesafaseblad aucilebelia
informaciis ramodenime wyaro: mSoblebi/momvleli, bavSvi,
skolis personali;
 kriteriumebi dakavSirebulia problemis aRmocenebis asakTan,
xangrZlivobasTan, gavrcelebasTan (sxvadasxva garemoSi

21
 gamovlena, mag-skola, saxli, amxanagebi) da CamorCenasTan.
maTi erTobliobiT SesaZloa daisvas ADHD-s diagnozi.

5. xva pirveladi da komorbiduli mdgomareobebis arsebobis

Sefaseba – ix. Tavi 5.2. diferenciuli diagnozi.
Tu gamokvlevis periodSi gamovlinda alternatiuli pirveladi
diagnozi, unda moxdes identificirebuli problemis Sesabamisi
marTva (gaidlainis gareT).

diferenciuli diagnozi
ADHD-isaTvis damaxasiaTebeli simptomebi xSiria sxva fsiqiuri
janmrTelobis problemebis dros. aqedan gamomdinare, eWvis dros
gaTvaliswinebuli unda iyos rogorc yuradRebis deficitis an
hiperaqtiuloba/impulsurobis gamomwvevi sxva daavadebebis arseboba,
aseve komorbiduli aSlilobac. Ees orive faqtori, Tavis mxriv,
mxedvelobaSia misaRebi.

ADHD-is mqone bavSvTa diferenciuli diagnozi da komorbiduli

daavadebebis Sefaseba
qvemoTCamoTvlili xuTi sferos skriningi uzrunvelyofs
monacemebs ADHD-s diferencialuri diagnozisaTvis.
1. biosamedicino problemebi:
2. emociur/fsiqiatriuli problemebi
3. ojaxuri/fsiqosocialuri problemebi;
4. metyvelebis/enobrivi problemebi;
5. akademiuri moswrebis / swavlebis problemebi

1. biosamedicino problemebi.
mTavari sakiTxebi:
 aucilebelia anamnezisa da fizikuri/nevrologiuri/ganviTare-
bis Sefaseba, raTa identificirebul an gamoricxul iqnas
ADHD-is arseboba.
 anamnezsa da samedicino Semowmebaze dayrdnobiT, SeiZleba
gansazRvrul iqnas Semdgomi klinikuri gamokvlevebi iseT
sferoSi, rogoricaa genetikuri (qromosomuri), nevrologiuri
an biosamedicino problemebi.

22
janmrTelobis istoria da fizikuri/nevroloiuri/ganviTarebis
Sefaseba aucilebelia imisaTvis, raTa gansazRvrul an
gamoricxul iqnas biosamedicino areSi ADHD-s diferencialuri
diagnozis problemebi. sensorul sferoSi (anu smena da mxedveloba)
problemebma SeiZleba gamoiwvion sirTuleebi saklaso oTaxSi, rac
SeiZleba gamoixatos mousvenar an uyuradRebo qcevaSi.
nevrologiuri Seferxebis an nevrologiuri `rbili niSnebis~ mqone
bavSvebi swavlebis aTvisebasTan dakavSirebuli moSlilobebis da
qceviTi moSlilobebis riskis qveS imyofebian60. (R)

zogadi janmrTelobis istoria da samedicino daTvaliereba

gulisxmobs:
 zrdis parametrebi: simaRle, wona;
 ZiriTadi parametrebi: sisxlis wneva, pulsi;
 mxedvelobis da smenis skriningi.

specialuri yuradReba unda gamaxvildes:

 zogad fizikur ganviTarebaze
- mcire fizikuri anomaliebi SeiZleba iyos genetikuri
anomaliebis, darRvevebis (dabla ganlagebuli yurebi, didi an
saTesle parkebSi Camousvleli saTesle jirkvlebi, Zlier
amozneqili sasa da a. S.) maniSnebeli;
 wamaldamokidebulebis niSnebi da simptomebi;
 nevrologiuri gamokvleva:
- darRvevebi (magaliTad, motoruli an metyvelebis dambla,
refleqsebis asimetria, an anomalia, an tremori);
- odnav SesamCnevi nevrologiuri niSnebi, maT Soris
sirTuleebi moqmedebebis Tanmimdevrobis gansazRvrasTan,
aritmiasTan, sarkisebur gamosaxulebasTan, motorul
siWarbesTan da mouqnelobasTan dakavSirebiT. `mouqnelobas~
ganekuTvneba zusti an zogadi (miaxloebiTi) samoZrao
amocanebis Sesrulebis winaswari, neli, araregularuli an
araTanmimdevruli moqmedebebi;
 ganviTarebis statusis Sefaseba:
- bavSvebis aqtiurobis, saTanadod urTierTobis, miTiTebebis
midevnebis SesaZleblobasa da TanamSromlobaze dakvirveba
gamokvlevaTa kabinetSi;
 Seferxebebis an problemebis istoria:

23
 - smeniTi aRqma;
- eqspresiuli metyveleba;
- monacemTa vizualuri an Tanmimdevruli damuSaveba;
- mexsiereba;
- natifi da uxeSi motorika;
 kognitiuri CamorCenis skriningi.
samedicino muSakma SeiZleba gamosadegad CaTvalos qvemoT
CamoTvlili. pasuxi (reaqcia) asakzea damokidebuli.
- sTxoveT bavSvs isaubros bolodroindel movlenaze _
dabadebis dReze, sportul Sejibrebaze da a.S. (miaqcieT
yuradReba, ramdenad Tavisufali, dalagebuli da orga-
nizebulia misi metyveleba);
- hkiTxeT mSoblebs, aqvs Tu ara bavSvs sirTuleebi sate-
lefono mesijebis miRebisas an saklaso oTaxSi miRebuli
instruqciebis damaxsovrebisas, asakTan SesabamisobaSi
(moklevadiani maxsovroba);
- daakvirdiT bavSvs, rodesac is iyenebs fanqars simboloebis
an sityvebis gadawerisas (vizualuri percefciul-motoruli)
- sTxoveT bavSvs Seasrulos samsvliani brZaneba (moqmedebaTa
Tanmimdebroba);
- sTxoveT bavSvs gaimeoros oTxi sityva, daimaxsovros isini
da kidev erTxel gaimeoros, isini 5 an 10 wuTis Semdeg
(maxsovroba, yuradReba);
- sTxoveT bavSvs gaimeoros sami, Semdeg oTxi cifri
TanmimdevrobiT, Semdeg gaimeoros jer sami, xolo Semdgom
oTxi cifri ukumimarTulebiT (koncentracia);

anamnezsa da samedicino daTvalierebaze dayrdnobiT, momdevno

gamokvleva SeiZleba ganisazRvros iseTi sferoebiT, rogoricaa:
 genetikuri an qromosomuli
o myife X sindromi o turetis sindromi
o mentaluri CamorCena o neirofibromatozi
 nevrologiuri
o krunCxviTi aSliloba o cnsis infeqcia infeqcia
o qoreoformuli aSliloba o cns-is travma
o neirodegeneraciuli daavadebebi

24
  biosamedicino
o toqsinebi (tyvia, fetaluri alkoholuri sindromi,
kokainis prenataluri zemoqmedeba);
o alergia;
o smeniTi an vizualuri darRveva;
o metaboluri/endokrinuli;
o anemia;
o Zilis moSlilobebma SeiZleba gamoiwvion iseTi qceva,
romelic SeiZleba miemsgavsos msubuqi formis ADHD-s,
da aseve gaamwvavos saSualo an Zlieri ADHD-s
simptomebi. Zili guldasmiT unda iqnas Semowmebuli.61 (C)
mtkicebulebebis klasi C, D .

2. emociuri/fsiqiatriuli problemebi
mTavari momentebi:
 ADHD-s mqone bavSvebs depresiis, SfoTviTi moSlilobebis,
qceviTi moSlilobis da wamalTdamokidebulebis momatebuli
riski aqvT;
 klinicistebma yvela ADHD-s mqone pacientTan intervius
dros unda gamoikvlion es Tanmxlebi daavadebebi;
 autisturi speqtris moSlilobis mqone bavSvebs SeiZleba
hqondeT ADHD-s simptomebis niSnebi, magram autisturi
speqtris simtomebi unda CaiTvalos ZiriTadad.
ADHD-s diagnozis dasma SeiZleba garTulebuli iyos an sxva
Tanarsebuli fsiqiatriuli daavadebis, an kidev, iseTi
fsiqiatriuli daavadebis arsebobiT, romelsac ADHD-s
damaxasiaTebeli simptomebi aqvs. rogorc cnobilia, yuradRebis
deficitisa da hiperaqtivobis mqone bavSvebi imyofebian
depresiis, SfoTviTi moSlilobebis, qceviTi moSlilobebis da
wamalTdamokidebulebis momatebuli riskis qveS. am daavadebebis
prevalirebis diapazoni ADHD-s mqone bavSvebSi 15-dan 30%-mdea.
klinicistis movaleobaa, Caataros zemoTCamoTvlili oTxi
daavadebis skriningi, rodesac amowmebs iseT bavSvs, roelsac
aReniSneba ADHD-s simptomebi62.
mtkicebuleba C, R.

25
 qvemoT ganxilulia depresiis, SfoTviTi moSlilobebis, qceviTi
moSlilobebisa da wamalTdamokidebulebis SesaZlo arsebobis
damadasturebeli simptomebi.

depresia
 mudmivi depresiuli an gaRizianebuli xasiaTi TiTqmis
yoveldRe, rac grZeldeba rogorc minimum ori kvira;
 mniSvnelovnad Semcirebuli interesi an siamovneba yvela
an TiTqmis yvela saqmianobisgan;
 saskolo davalebis an samuSaos Sesrulebis xarisxis
aSkara daqveiTeba;
 drodadro ganmeorebiTi suiciduri azrebi raime
konkretuli gegmis gareSe, an periodulad ganmeorebiTi
fiqri sikvdilze;
 mdgradi gauTavebeli depresiuli ganwyoba dakavSirebuli
TiTqmis yoveldRiur uZilobasTan an hipersomniasTan
(zedmetad momatebuli Zilianoba).
iuveniluri maniakalur-bipolaruli aSliloba
bolo drois gamocdileba gvaZlevs saSualebas vivaraudoT
garkveuli Tanxvedra ADHD-sa da iuvenilur maniakalur-
bipolarul aSlilobas Soris. qvemoT mocemuli warmoadgens
sabavSvo periodis maniis maxasiaTebel niSnebs, ramac SeiZleba
xeli Seuwyos klinicists am ori daavadebis diferencirebaSi:
 maniakalur-bipolaruli aSliloba Zalzed iSviaTia, ADHD-
sTan SedarebiT;
 simptomebi moicavs afeqturi Setevebis swrafad gamoCenas,
gaxangrZlivebul Zlier ganrisxebis afeTqebebs,
gaafrTebul mZvinvare agresiulobas, gaRizianebadobas,
cvalebad interpersonalur urTierTobas;
 Cveulebriv, Tanaarsebobs depresiasTan erTad.

SfoTviTi aSliloba
posttravmuli stresuli aSliloba da SfoTviTi aSliloba 2
yvelaze gavrcelebuli mdgomareobaa, romelic SesaZloa ADHD-s
msgavsi klinikiT mimdinareobdes. posttravmuli stresuli
aSlilobis yvelaze gavrcelebuli mizezebia fizikuri da
seqsualuri Zaladoba. Ffsiqologiuri anamnezi unda gamovikvlioT
zedmiwevniT da unda ganvixiloT, rogorc mTliani Sefasebis

26
nawili. sxva diagnozebi, romlebic ufro saxezea sabavSvo asakSi,
moicavs separaciuli gangaSis aSlilobas da generalizebul
SfoTviT aSlilobas. skriningi, romelic SeiZleba gamosadegari
iyos am daavadebebis identifikaciisas, mocemulia qvemoT.
 ganviTarebis donesTan Seusabamo da gadametebuli SfoTva,
romelic gamowveulia saxlisagan an im pirebTan daSorebiT,
visTanac bavSvi miCveulia yofnas;
 mudmivi an gadametebuli SfoTva Zalian axlobeli adamianebis
dakargvis SiSisa da im savaraudo zianis gamo, romelic
SeiZleba maT miadgeT;
 ganmeorebadi Civili an fizikuri simptomebi, romelic
dakavSirebulia axlobel adamianebTan ukve Semdgar, an mosa-
lodnel daSorebasTan;
 zedmeti TviTgvema dabali moswrebis gamo (magaliTad,
skolaSi miRebuli Sefaseba);
 bavSvisTvis rTuli xdeba misi SfoTvis/Sewuxebis gakon-
troleba an SeCereba.

qceviTi aSliloba
 negatiuri, mtruli da gamomwvevi qcevis arseboba, rac
SeiZleba moicavdes mwyobridan gamosvlas, mozrdilebTan
kamaTs, mozrdilebis moTxovnebis dakmayofilebaze (damorCi-
lebaze) uaris Tqmas, ganzrax adamianebisTvis Tavis
mobezrebas, mudmiv risxvas da sxvebis mimarT gamoxatul
ukmayofilebas (gaRizianeba);
 adamianebsa Tu cxovelebis mimarT fizikur agresia;
 qurdobaSi ganzrax monawileoba;
 potenciurad seriozuli SedegebiT dasrulebuli wesebis
darRveva (magaliTad, saxlidan gaqceva, skolis gacdena);
 qcevis darRveva iwvevs klinikurad minSvelovan darRvevas
socialur, akademiur an SromiT saqmianobaSi.

wamaldamokidebuleba (narkomania/alkoholizmi)
 alkoholis an nebismieri saxis dauSvebeli wamlebis
(narkotikebis) gamoyeneba anamnezSi;
 alkoholis an narkotikebis gamoyeneba ganwyobis Sesa-
cvlelad an cudi ganwyobisgan Tavis dasaRwevad;

27
  problemebi skolaSi, saxlSi an kanonier xelisuflebasTan,
romelic dakavSirebulia pacientis mier alkoholis an
narkotikebis miRebasTan;
 Tanatolebisagan miRebuli informacia pacientis mier
alkoholis an narkotikebis moxmarebasTan dakavSirebiT;
 alkoholis an narkotikebis moxmarebis gamo sakuTari Tavis
dadanaSauleba;
 qceva, romelic migvaniSnebs alkoholis an narkotikebis
moxmarebaze (gazrdili izolacia ojaxisa da megobrebisagan,
narkotikuli nivTierebebis misaRebi mowyobilobebis
arseboba).

farTod gavrcelebuli, ganviTarebasTan dakavSirebuli moSli-

lobebi (magaliTad, autisturi aSliloba, aspergeris sindromi)
arc Tu ise iSviaTad autisturi speqtris aSlilobis mqone
bavSvebs saxeze aqvT ADHD-s damaxasiaTebeli niSnebi. am
bavSvebisTvis tipiuri da problematuria:
 sazogado urTierTobis xarisxobrivi gauareseba (mag.
Tanaziaroba, araverbaluri Jestebi, erToblivi monawileoba
saqmianobaSi, urTierToba TanatolebTan);
 xarisxobrivi gauareseba komunikaciisas (mag. metyvelebis
Seferxebebi, sasaubro metyveleba, idiosinkrazi-
uli/stereotipuri metyveleba, simboluri/imitaciuri TamaSi);
 qcevis SezRuduli, ganmeorebadi modeli (magaliTad,
SeSfoTeba (winaswarSegoneba), ritualebi, TviT-stimulato-
ruli motoruli manerizmi.

3. ojaxuri/fsiqologiuri problemebi
mTavari momentebi:
 qronikulma an mwvave stresebma SeiZleba gamoiwvion
cvlileba bavSvis akademiur moswrebaSi an qceviT funqcio-
nirebaSi, rogoricaa ADHD-s simptomebis imitacia an
arsebuli simptomebis gamwvaveba.
 SeafaseT ojaxSi arsebuli fsiqikuri daavadebebis istoria.
ADHD-s qvetipebi icvleba ojaxSi arsebuli fsiqikuri
daavadebis tipis mixedviT.
 SeafaseT ojaxis funqcionireba, momvlel pirsa da bavSvis
urTierTobis bunebis, ojaxis SigniT simptomebis gavlenis da

28
 problemis daZlevis ojaxSi arsebuli resursebis
TvalsazrisiT.
garda Tanmxlebi fsiqiatriuli an swavlebis aTvisebasTan
dakavSirebuli problemebis Sefasebisa, mniSvnelovania im fsiqo-
logiuri konteqstis gaTvaliswineba, romelSiac aRmocendeba
bavSvis simptomebi da problemebi. qvemoT identificirebulia
gasaTvaliswinebeli faqtorebi da zogierTi mosazrebani intervius
dros dasasmeli kiTxvebis Sesaxeb. ojaxis funqcionirebis
guldasmiTi Sefaseba xels Segviwyobs bavSvTa simptomebis rogorc
bunebisa, aseve simZimis gaTviTcnobierebaSi da agreTve ojaxis
unaris gagebaSi gamoiyenos ganaTlebasTan da mkurnalobasTan
dakavSirebuli rekomendaciebi. Tu saxezea mniSvnelovani ojaxuri
paTologia, maSin aucilebelia mimarTva fsiqiatrTan, ojaxis
eqimTan an socialur samsaxurebSi.

fsiqologiuri stresorebi
arsebobs garkveuli mtkicebulebebi (faqtebi) imisa, rom ADHD-s da
erTdroulad moqmedi depresiuli an SfoTviTi daavadebebis mqone
bavSvebs cxovrebiseuli stresebis da dedis mxridan arsebuli
fsiqiatriuli simptomebis ufro maRali done aqvT63 (C).
qronikuli an mwvave stresebi bavSvis funqcionirebaSi SeiZleba
sxvadasxva gziT gamomJRavndes; zogadi simptomebi moicavs SfoTvas,
disforias (uxalisobas) da qceviT reagirebas. am sirTuleTagan
nebismierma SeiZleba gamoiwvios akademiuri moswrebis an Sinaur
garemoSi qcevis cvlileba.
stresiT aRsavse cxovrebiseuli movlenebi SeiZleba moicavdes:
 did cxovrebiseul gardaqmnebs da cvlilebebs (sacxovrebeli
adgilis an skolis Secvla);
 danaklisebi (sayvareli adamianis gardacvaleba, mSoblebis
daSoreba);
 Zaladoba (seqsualuri an fizikuri, ojaxuri Zaladoba);
 travmatizmi (magaliTad sagzao SemTxveva).

ojaxuri istoria
ADHD-s qvetipebi icvleba ara marto Tanmxlebi daavadebebis,
aramed aseve ojaxis istoriaze dayrdnobiT. ADHD-s hiperaqtiuri
impulsuri qvetipis mqone bavSvebis ojaxebSi ufro metia ADHD-s,
agresiisa da wamalTdamokidebulebis SemTxvevebi, maSin roca
ADHD-s uyuradRebobis qvetipis mqone bavSvebis ojaxebSi ufro

29
metia SfoTviTi aSlilobebi da swavlasTan dakavSirebuli
problemebi64.
sanimuSo kiTxva problemis gamosavlenad: mkurnalobda Tu ara
vinme Tqvens ojaxSi (mSoblebi, da-Zmebi da sxva naTesavebi):
 SfoTviTi aSlilobis gamo;
 depresiuli aSlilobis gamo (maT Soris, bipolaruli aSli-
loba);
 swavlasTan/yuradRebasTan dakavSirebuli problemebis gamo;
 ganviTarebis Seferxebis, gonebrivi CamorCenis an autizmis
gao;
 wamaldamokidebulebis gamo;
 qceviTi problemebis gamo;
 sxva fsiqikur janmrTelobasTan dakavSirebuli problemebis
gamo.

mzrunvelobis (meTvalyureobis) xarisxi

ganixileT ojaxis unari da resursebi sirTuleebis daZlevaSi,
iseve rogorc maTi rwmena da kompetencia bavSvis problemebTan
dakavSirebiT. aseve gamoikvlieT mTlianobaSi ojaxze bavSvis
simptomebis gavlena.
gamohkiTxeT momvlelebs ojaxSi arsebuli garemos Sesaxeb. kerZod,
SeafaseT is problemebi, romlebmac SeiZleba negatiuri zegavlena
moaxdinon mSobelTa SesaZleblobaze, Tanmimdevrulad da
saTanadod marTon qceva, uzrunvelyon adeqvaturi meurveoba
Seafason bavSvis funqcionireba.
am problemebs miekuTvneba:
 mSoblebis fsiqiatriuli aSliloba an qimiuri midre-
kileba/damokidebuleba;
 kulturuli gansxvavebebi;
 ganaTlebis an informaciis nakleboba;
 dabali inteleqtualuri done;
 ojaxuri/sazogadoebis mxardaWeris ararseboba;
 fsiqologiuri stresorebi (ix. zemoT), da
 bavSvze SezRuduli mzrunveloba.

30
sanimuSo kiTxvebi:
 rogoria Tqvens ojaxSi Cveulebrivi tipiuri dRe?
 grZnobs Tu ara bavSvi skolis da zogadad sazogadoebis
mxardaWeras?
 vin uwevs daxmarebas Tqvens Svils, rodesac Tqven es
gWirdebaT?
 xdeba Tu ara alkoholis an dauSvebeli wamlebis (narko-
tikebis) moxmareba Tqvens ojaxSi?
 SegiZliaT momiyveT ra gsmeniaT an giswavliaT ADHD-s
Sesaxeb?
 disciplinis ra saxeoba moqmedebs (an ar moqmedebs) Tqvens
Svilze?
 rodis grZnobT siamovnebas Tqvens bavSvTan yofnisas?
mtkicebuleba C, R klasisaa.

4. metyvelebis/laparakis problemebi
mTavari momentebi:
 Tu skriningi mianiSnebs problemebze bavSvis metyvelebasa
da/an laparakTan dakavSirebiT, maT Soris eqspresiul da
receptul metyvelebas, mwyobr metyvelebas, pragmatul
metyvelebas, prosodias (leqsTa SeTxzvas), an
fonologia/artikulaciis problemebs, aucilebelia
gaigzavnos metyvelebisa da saubris paTologistTan.
 Tu saxezea saubris an metyvelebis problemebi, romlebic
mogvagonebs fsiqologiuri ganviTarebis zogad aSlilobas,
maSin aucilebelia mimarTva ganviTarebis an fsiqikuri
janmrTelobis profesionalebTan, diagnostikur jgufSi
saubris da metyvelebis specialistis monawileobiT.
 ADHD-s mqone bavSvebi imyofebian xmis iogebis “araswori
gamoyenebis~ momatebuli riskis qveS. Tu aRmoCnda, rom bavSvs
aqvs qronikuli (6 Tve da meti) “Wriala” an xrinwiani xma,
maSin rekomendebulia otolaringologTan mimarTva xmis
iogebis paTologiis dadgenis mizniT, rogoricaa xmis iogebis
gasqeleba an xmis iogebis kvanZebi.
 ADHD-s mqone bavSvebSi periodulad ganmeorebadi xmebis,
yelis gasufTavebis mcdelobis, qSinvis, xvelis an kopro-
laliis (uxamsi sityvebis impulsuri warmoTqma) arseboba
migvaniSnebs toretis Tanmxleb sindromze. am dros

31
 rekomendebulia konsultacia nevrologTan, ganviTarebis da
qceviTi problemebis pediatrTan, an bavSvTa fsiqiatrTan.
ADHD-s mqone bavSvebis 50%-s SeiZleba aRmoaCndes metyvelebis
problemebi. verbaluri funqcionirebis problemebi SesaZloa,
qronikuli iyos da gansakuTrebiTaa gavrcelebuli antisocialuri
qcevis mqone mozardebSi. metyvelebis da saubris Seferxebis
farTod gavrcelebuli sirTuleebia:
 mwyobri metyvelebis dakargvasTan dakavSirebuli warsuli da
axlandeli problemebi;
 araorganizebuli metyveleba iseTi amocanebis Sesrulebisas,
romlebic moiTxovs verbalur axsnas;
 moWarbebuli (zedmeti), zedapiruli an swrafi metyveleba;
 problemebi xmis tembris modulaciasTan;
 fragmentaruli winadadebebi pauzebiT.
metyvelebis problemebi SeiZleba aseve aRmocendes ADHD-s mqone
bavSvebSi an SeiZleba warmoadgendes Tanmxleb daavadebas. aseTma
bavSvebma SeiZleba moaxdinon yuradRebasTan dakavSirebuli
pirvelxarisxovani mniSvnelobis problemebis imitireba da hqondeT
problemebi miTiTebebis midevnebisas da verbalurad warmodgenili
masalis damaxsovrebisas65 (C).
ADHD-s mqone bavSvTa umetesoba amJRavnebs `pragmatul sasaubro
disfunqcias~ socialur situaciebSi _ kerZod, gamorCeuli
verbaluri, araverbaluri da situaciuri miniSnebebis amocnobis
uZluroba. aman SeiZleba gamoiwvios socialurad miuRebeli
arCevnis gakeTebis tendencia. ADHD-s mqone bavSvebis 50%-ze mets
savaraudod aqvT sakomunikacio/saurTierTobo problemebi, rac
mJRavndeba rogorc socialuri unarebis deficiti. klinicistma
unda gamoikiTxos agresiuli, despoturi da momabezrebeli
socialuri urTierTobis stilis, aseve megobrobis inicirebis da
SenarCunebis sirTuleebis da Tundac Tanatolebis mxridan
pirdapiri miuReblobis faqtebis Sesaxeb.

smenis darRvevebi
smenis darRvevebis mqone bavSvebs aseve SeiZleba hqondeT ADHD,
maTi smenasTan dakavSirebuli problemebis garda. Aaman SeiZleba
gaarTulos diferencialuri diagnozi da aseT SemTxvevaSi saWiroa
specialistebis konsultacia. 66(R). smenis darRvevebis mqone bavSvebs
SeiZleba aseve gamoumJRavndes uyuradRebobis simptomebi,
problemebi amocanis dasrulebasTan dakavSirebiT, cudi, agresiuli
qceva, daumorCilebloba (reJimis darRveva), saubris da metyvelebis

32
problemebi an informaciis xSiri ganmeorebis saWiroeba. yvela im
bavSvs, romelic mowmdeba ADHD-ze, unda hqonoda Catarebuli
smenis skriningi bolo 12 Tvis ganmavlobaSi, Tu smenis
daqveiTebaze mainc Cndeba eWvi, saWiroa audiogramis Catareba.

ganviTarebis perversiuli aSliloba (mag. autisturi aSliloba,

aspergeris sindromi)
perversiuli aSlilobis maniSnebeli niSnebi saubris/metyvelebis
TvalsazrisiT moicavs:
 gadaWarbebul TavisTavTan saubars;
 uCveulo intonaciur models an monotonurobas;
 eqolalias (eqofrazias, sityvebis gauazrebel ganmeorebas);
 iseT qmedebas, TiTqos ar esmis;
 socialurad arasaTanado qcevas (mag. yvirils, saubarSi
Carevas);
 manamde SeZenili enobrivi unarebis dakargvas.
Tu arsebobs saubris da metyvelebis problemebi, romlebic
migvaniSnebs fsiqologiuri ganviTarebis aSlilobaze, aucilebelia
pacientis gagzavna ganviTarebis an fsiqologiuri janmrTelobis
profesionalTan, diagnostikur gundSi saubrisa da metyvelebis
specialistis CarTva.
ADHD-s mqone pacientebma, romlebsac aqvT Tanmxlebi saxmo iogebis
an turetis sindromi SeiZleba gamoamJRavnon saubris iseTi modeli,
romelic tipiuria aseTi pacientebisaTvis, maT Soris, periodulad
ganmeorebadi xmebi, yelis gasufTavebis mcdelobis, qSinva, xvela
da Tundac koprolalia (uxamsi sityvebis impulsuri warmoTqma).
SeiZleba mizanSewonili iyos konsultacia nevrologTan,
ganviTarebis da qceviTi problemebis pediatrTan an bavSTa
fsiqiatrTan.
mtkicebuleba D, R klasisaa.

5. akademiuri moswrebis/swavlasTan dakavSirebuli problemebi

mTavari momentebi:
 ADHD-s mqone bavSvebis daaxloebiT 25-30%-s aseve aqvs speci-
fikuri akademiuri unarebis deficiti an `swavlebis
aTvisebasTan dakavSirebuli aSliloba~ iseT sferoebSi,
rogoricaa kiTxva, marTlwera an maTematika.

33
  dabali inteleqtis mqone bavSvebi SeiZleba Candnen
uyuradReboni gaazrebis an masalis srulad aTvisebis
naklebobis gamo. aseT bavSvebs ufro xSirad aqvT Tanmxlebi
ADHD, vidre sxva bavSvebs.
 Tu anamnezi da skriningi migvaniSnebs mniSvnelovan proble-
mebze akademiuri funqcionirebisa, bavSvma unda gaiaros
individualuri kognitiuri/fsiqoganmanaTlebeli Sefaseba.
ADHD-s mqone bavSvebi arian akademiurad CamorCenis momatebuli
riskis qveS da xSirad moixseniebian rogorc dabali moswrebis
mqoneebi. istoria unda moicavdes mSoblebisa da maswavleblebisgan
miRebul informacias, raTa Sefasebul iqnas ADHD-s mqone
bavSvebSi problemuri sferoebi, romlebic moicavs:
 damoukidebeli muSaobis droulad dasrulebas;
 yuradReba detalebis mimarT;
 momzadeba gamocdebisaTvis;
 Canawerebis gakeTeba saklaso oTaxSi mosmenili leqciebis
Sesaxeb;
 saorganizacio unarebi;
 drois dagegmva;
 sakuTar Tavze dakvirveba.
empiriulad miRebuli mtkicebulebebi migvaniSnebs mdgrad kavSirze
ADHD-sa da swavlebis sirTuleebTan dakavSirebul aSlilobas
Soris. ADHD-s mqone yoveli sami-oTxi bavSvidan erTs aqvs
konkretuli akademiuri moswrebis problema an `swavlebis
aTvisebasTan dakavSirebuli aSliloba~, iseT tradiciulad
gansazRvrul sferoebSi, rogoricaa kiTxva, marTlwera an
maTematika. swavlebis sirTuleebTan dakavSirebuli aSliloba
formalurad ganisazRvreba sxva studentTa IQ-s (inteleqtis
koeficienti) qulebis SedarebiT mis qulebTan.
swavlebis sirTuleebi an aSliloba amJamad ganisazRvreba DSM-IV-
iT da moicavs:
 problemebs kiTxvisas;
 problemebs maTematikaSi;
 problemebs weriTi gamosaxvisa da
 ganviTarebasTan dakavSirebul koordinaciis aSlilobas.
dabali inteleqtis mqone bavSvebi SeiZleba Candnen uyuradReboni
gaazrebis problemis gamo da im masalis aTvisebisas, romelic

34
zedmetad rTulia maTTvis. Tumca, aseve mniSvnelovania imis
aRniSvna, rom kognitiuri darRvevebis mqone bavSvebs 3-4 jer ufro
xSirad aqvT ADHD, vidre bavSvebs, romelTa inteleqtis maCvenebeli
normalur diapazonSia. Sesabamisad, IQ-s Sefaseba da
individualuri miRwevebis testireba SeiZleba xSirad iyos ADHD-s
Sefasebis aucilebeli Semadgeneli nawili. mniSvnelovania imis
aRniSvna, rom aseT bavSvebs SeiZleba araswori diagnozi daesvas
rogorc yuradRebasTan dakavSirebuli problemebis mqoneebs, maSin
roca sinamdvileSi maTi simptomebi meoradia.
mniSvnelovania saskolo problemebis gadaxedva pacientTan, mSob-
lebTan, maswavleblebTan da skolis sxva profesionalebTan erTad.
swavlebis sirTuleebi SeiZleba moicavdes moicavdes Semdeg
simptomebs:
 aSkara apaTias an mtrul ganwyobilebas skolisadmi;
 Tavis daRwevas an warumateblobas konkretuli sagnebis
sferoSi;
 cud (agresiul) an uaryofiT qcevas garkveul klasebSi;
 konkretuli unarebis sferoSi arsebuli sirTuleebis
dokumentirebul mtkicebulebebs;
SesaZlo kiTxvebis magaliTi, romliTac mimarTaven bavSvebs da maT
mSoblebs akademiuri moswrebis im sakiTxebis SefasebisaTvis,
romlebic warmodgenilia ADHD-s Sefasebis konteqstSi, SeiZleba
moicavdes:
 romeli sagania TqvenTvis yvelaze sayvareli/advili?
 romeli sagania yvelaze rTuli/naklebad sayvareli?
 rogor eguebiT da ra urTierToba gaqvT maswavleblebTan?
 ra moculobis saSinao davalebas asrulebT saSualod
saRamos saaTebSi? rogor Seefereba es saSinao davaleba im
moculobas, romelsac asruleben Tqveni Tanaklaselebi?
ramdenad gexmarebian Tqveni mSoblebi saSinao davalebis
SesrulebaSi?
 ra niSnebs Rebulobs TiToeuli maTgani klasSi? rogor
Seefereba es wina wlebSi miRebul niSnebs? hqondaT Tu ara
adre warumatebloba an amJamad xom ar gaqvT problemebi
swavlebisas?
 giweven Tu ara raime specialur daxmarebas skolaSi?
 ra interesebi gagaCniaT skolis farglebs gareT?

35
  aqvs Tu ara Tqvens vaJiSvils/qaliSvils raime problemebi
swavlebis/saorganizacio unar- CvevebTan dakavSirebiT?
 raSia Tqveni azriT Tqveni vaJiSvilis/qaliSvilis saswavlo
stilis siZliere? sisuste?
 rogor fiqrobT, ganwyobilia Tu ara Tqveni bavSvi
pozitiurad skolis mimarT?
 gekontaqtebodaT Tu ara odesme vinme skolidan Tqveni Svilis
konkretuli akademiuri moswrebis an qcevis problemebTan
dakavSirebiT?
 kmayofili xarT Tqveni Svilis niSnebiT?
 rogor grZnobT, amJRavnebs Tqveni vaJiSvili/qaliSvili Tavis
potencials?
“gansakuTrebuli niWiT dajildoebulma” studentebma kognitiur
sferoSi cvlilebebiT, SeiZleba aseve gamoamJRavnon ADHD-s iseTi
niSnebi an simptomebi, rogoricaa uyuradReboba, cudi (agresiuli)
qceva da saklaso oTaxSi gamarTuli saqmianobaSi CarTulobis
aSkara nakleboba. mniSvnelovania imis aRniSvna, rom aseT bavSvebs
SeiZleba araswori diagnozi daesvas, rogorc ZiriTadad
yuradRebis deficitTan dakavSirebuli problemebis mqoneebs, maSin
roca sinamdvileSi maTi simptomebi meoradia. Tumca
“gansakuTrebuli niWiT dajildoveba” (niWiereba) da ADHD SeiZleba
erTdroulad arsebobdes.
prospeqtuli klinikuri dakvirvebebi ADHD-s mqone bavSvebze
mozrdil asakSi migvaniSnebs, rom es populacia imyofeba qroni-
kuli warumateblobisa (miuRwevlobis) da skolidan garicxvis
momatebuli riskis qveS.
mtkicebulebebi C klasisaa.

36
6. mkurnaloba
zogadi rekomendaciebi
 ADHD-s medikamenturi mkurnaloba unda dainiSnos mxolod
ADHD-ze specializebuli fsiqiatris, nevrologis an
pediatris mier;
 pirveli rigis mkurnaloba ADHD-is mqone pacientTa
umravlesobisaTvis mastimulirebeli medikamentebia (A);
 Cveulebriv, adekvaturad monitorirebuli farmakoTerapia
metad efeqturia, vidre mxolod intensiuri qceviTi Terapia
(B).
 skolamdeli asakis bavSvebTan medikamenturi Terapia ar aris
rekomendebuli (D);
 medikamentur TerapiasTan erTad aucilebelia qceviTi,
saganmanaTleblo, fsiqologiuri rCevebi da aqtivobebi,
medikameturi da kognitur-qceviTi Terapiis kombinacia ufro
efeqturia, vidre nebismieri maTgani cal-calke (A) 67;
 medikamenturi mkurnalobis dawyebamde unda Catardes ekg im
pacientebTan, romelTac gasinjvisas aRmoaCndaT raime
paTologiuri cvlilebebi gul-sisxlZarRvTa sistemis mxriv,
an aReniSnebaT anamnezSi gulis daavadeba, an aqvT gulis
seriozuli daavadebis, an axalgazrda asakSi uecari
sikvdilis ojaxuri anamnezi.

farmakologiuri mkurnaloba
mniSvnelovania gaviTvaliswinoT, rom ADHD-s medikamenturi
mkurnalobis daniSvna, iseve, rogorc mkurnalobis sqemis Secvla an
gadawyvetilebis miReba mkurnalobis Sewyvetis Sesaxeb unda moxdes
specializebuli fsiqiatris, nevrologis an pediatris mier.
pirveli rigis medikamenturi Terapia ADHD-s SemTxvevaSi
stimulantebia 68 . ormagi brma, placebo-kontrolirebadi kvlevis
mixedviT, klinikuri gaumjobeseba aReniSnaT ADHD-s mqone
pacientTa 60-75%-s stimulantebis jgufidan xolo sakontrolo
jgufidan – 4-30%-s 69 . arCevani Tavisufalia stimulantebis 2 tipis
medikamentebs Soris – amfetaminis warmoebulebsa da
metilfenidinis warmoebulebs Soris da maTi efeqturoba
Tanabaria 70 . kvlevebis mixedviT, am medikamentTa gaxangrZlivebuli
formebi iseve efeqturi ADHD-s samkurnalod bavSvebSi da
mozrdilebSi, rogorc xanmokle formebi 71 , (B). atomoqsetini,

37
noradrenerguli ukumitacebis seleqtiuri inhibitori, meore rigis
medikamentia da misi efeqturoba dadasturebulia randomizebuli,
placebo-kontrolirebadi kvlevebiT 72 , 73 . sxva medikamentebis
efeqturobaze, rogorica buproprioni, tricikluri
antidepresantebi da alfa2-agonistebi, mtkicebulebebi naklebadaa74.
mkurnaloba iwyeba dabali dozebiT da Semdeg xdeba dozis
titracia, rodesac pirveli rigis erTi medikamenti ar aris
efeqturi, jer unda icados aseve pirveli rigis meore medikamenti
da uefeqtobis SemTxvevaSi moxdes gadasvla meore rigis
medikamentze. SesaZlebelia medikamentis daniSvna gansxvavebuli
reJimebiT: mudmivi miReba an uqmeebze medikamentebisagan ”dasveneba”.
uqme dReebSi medikamentebisagan dasvenebis reJimi rekomendebulia
im bavSvebisaTvis, romelTac ADHD-s simptomebi ufro metad
saskolo saqmiaobaSi CamorCenis ganviTarebas ganapirobebs, an
mkurnalobis gverdiTi efeqtebis Semcirebaa aucilebeli. gverdiTi
efeqtebis Semcireba aseve SesaZlebelia medikamentis sakvebTan
erTad miRebiT an dozis SemcirebiT.
atomoqsetinis daniSvna unda moxdes im SemTxvevaSi, rodesac
stimulantebi araefeqturia, an mSoblebi arian stimulantebis
miRebis winaaRmdeg, an, rodesac savaraudoa pacientis, an ojaxis
wevrebis mier medikamentze damokidebuleba.

qceviTi Terapia
sworad warmaTuli kognitur-qceviTi Terapia medikamentur
TerapiasTan erTad saWiroebis SemTxvevaSi sakmaod efeqturia,
mniSvnelovania ojaxisa da momvlelis ganaTleba, mxardamWeri
jgufebis Seqmna, sadac ADHD-s diagnozis mqone bavSvis mSoblebi
erTmaneTs gauziareben TavianT gamocdilebas, sakmaod efeqturi da
gamocdili meTodia waxaliseba, magaliTad yvela karg saqcielze
an kargad Sesrulebul davalebaze prizis an qulis miniWeba75.
qceviTi Terapia 3 mimarTulebiT unda warmoebdes:
1. mSoblebze fokusirebuli strategia,
2. bavSvze fokursirebuli strategia
3. skolis personalze fokusirebuli strategia.

mSoblebze fokusirebuli strategia

mSoblebs unikaluri roli aqvT ADHD-s marTvaSi, maT aqvT

SesaZlebloba iyvnen Tavisi bavSvis gverdze sxvadasxva garemoSi da
arian mkveTrad motivirebulni, raTa gaakeTon maqsimumi Tavisi
Svilis warmatebuli momavlisaTvis. maTi survilia ixilon Svilis
warmateba ara marto swavlaSi, aramed yvela garemoSi – sportSi,

38
amxanagebTan da a.S.. mxolod isini imyofebian bavSvis gverdiT
xangrZlivi drois manZilze da maTi mizania, bavSvi gaxdes
sazogadoebis srulfasovani da kargad adaptirebuli wevri.
mSoblebi, romelTac gavlili aqvT specialuri treiningebi,
yvelaze ukeT axerxeben moagvaron qceviTi problemebi, romlebic
aReniSnebaT bavSvebs ADHD-Ti76 (R).
rCevebi mSoblebisaTvis:
 aRwereT bavSvis problemuri qceva (werilobiT), misi sixSire
da simZafre, raTa gaadvildes monitorireba da dinamikis
Sefaseba;
 gamoyaviT 10-15 wuTi dReSi mxolod bavSvisaTvis, mousmineT
mas, agrZnobineT, rom igi TqvenTvis Zalian mniSvnelovania;
 SeimuSaveT mkacri grafiki da rutinuli qcevebi, grafikidan
gadaxveva unda moxdes ukiduresad iSviaTad;
 daaweseT simboluri prizi yoveli kargi saqcielisaTvis,
dRis an kviris bolos daajameT prizebi bavSvis
TandaswrebiT;
 erTdroulad gaaxmovaneT msolod 1 an 2 martivi, mkafiod
Camoyalibebuli instruqcia, gaameorebineT bavSvs es
instruqcia, raTa darwmundaT, rom man kargad gaigo;
 ojaxis sxva wevrebisTvisac unda iyos qcevis wesebisa da
rutinebis nusxa, rom maTi qceva SesabamisobaSi iyos bavSvis
reJimTan;
 SeamcireT araadekvaturi qceva Semdegi meTodebiT:
 gaaanalizeT qceva bavSvTan erTad;
 logikurad auxseniT bavSvs qcevis araswori
buneba;
 aiReT “taim-autebi”, Tu TvliT, rom bavSvs Zalian uWirs
reJimis dacva an avlens agresias;
 SeimuSaveT Zilis mkafio Cveva, uzrunvelyaviT mSvidi garemo
bavSvis saZinebelSi;
 gamoyaviT mosaxerxebeli, izolirebuli oTaxi/kuTxe saSinao
davalebis Sesasruleblad;
 mieciT bavSvs arCevnis gakeTebis ufleba, magram SeTavazebebis
variantebi unda iyos SezRuduli da bavSvs hqondes
kontrolis arsebobis grZnoba;
 kargad auxseniT bavSvs, rom problemas warmoadgens misi
qceva da ara TviTon bavSvi;

39
bavSvze fokurirebuli strategia

mniSvnelovania bavSvma iswavlos qcevisa da emociebis marTva,

treiningis umTavresi mizania, bavSvi ADHD-Ti mieCios “gaCerebas da
dafiqrebas” moqmedebamde.

skolaze fokusirebuli strategia

swavlis Cvevebis gaumjobeseba

 saswavlo masala (davaleba) unda daiyos samuSao da samarTav
nawilebad, momdevno punqtze gadasvla unda moxdes mxolod
davalebis wina nawilis dasrulebis Semdeg;
 saklaso oTaxi unda iyos organizebuli, qcevis mkafio
wesebiT;
 bavSvis oTaxSi an samecadino kuTxeSi gamokruli unda iyos
dRis ganrigi, saSinao davalebebis micema unda moxdes
werilobiTi saxiT, bavSvi unda ijdes maswavlebelTan axlos
da mis gverdiT sasurvelia ijdes pozitiuri magaliTi –
bavSvi kargi qceviTi CvevebiT;
 unda daeTmos dro swavlis Cvevebisa da drois marTvis
swavlebas;
 sasurvelia xSiri, gegmiuri Sesvenebebi;
 dauyovneblivi pozitiuri ukukavSiri kargi qcevis
SemTxvevebSi;
 maswavlebelsa da mSobels Soris informaciis sistematiuri
gacvla, rac SesaZlebelia specialuri yoveldRiuri
baraTebis sistemis SemoRebiT;
 moswavlesTan TviTSefasebaze da TviTkontrolis Cvevevze
muSaoba, kompensatorul/adaptaciuri strategiebis SemuSaveba;

dakvirveba medikamenturi Terapiis gverdiT efeqtebze

zogadi rekomendaciebi
 rutinuli sisxlis analizi an ekg ar aris rekomendebuli Tu
ar aRiniSneba Sesabamisi Cveneba;
 RviZlis dazianeba atomoqsetinis iSviaTi da
idiosinkraziuli gverdiTi efeqtia – RviZlis funqciebis
rutinuli analizi ar aris rekomendebuli. mSobeli an
momvleli unda gafrTxeldes aRniSnuli gverdiTi moqmedebis
Sesaxeb (Cveulebriv gamovlindeba muclis tkiviliT, auxsneli
gulisreviTa da RebinebiT, Sardis gamuqebiTa da siyviTliT);

40
  qvemoTaRniSnuli monitorireba unda warmoebdes
meTilfenidatis, atomoqsetinisa da deqsamfetaminis miRebis
SemTxvevaSi, Tu sxvagvarad ar aris miTiTebuli.

simaRle (unda gakontroldes bavSvebi da mozardebi)

 unda gaizomos yovel 6 TveSi, zrdis mrudi unda Seafasos
eqimma, romelic iRebs gadawyvetilebas mkurnalobis Sesaxeb;
 Tu aRiniSneba mniSvnelovani CamorCena simaRleSi, unda
moxdes medikamenturi Terapiis Sewyveta ardadegebze, raTa
moxdes CamorCenis anazRaureba.

wona (unda gakontroldes bavSvebi, mozardebi da mozrdilebi)

 unda giazomos me-3 da me-6 Tveze mkurnalobis dawyebidan da
Semdeg yovel 6 TveSi. bavSvebisa da mozardebis SemTxvevaSi
unda Sedges zrdis Carti da Sefasdes mkurnali eqimis mier;
 Tu mozrdilebTan wonis kleba asocirebulia medikamentur
TerapiasTan, unda gakontroldes sxeuli masis indeqsi da
gadawydes medikamenturi Terapiis Sewyveta wonis persistuli
klebis SemTxvevaSi;
 bavSvebTan wonis regulaciisaTvis Semdegi gzebia
mowodebuli:
o medikamentis miReba unda moxdes Wamis dros an Wamis
Semdeg nacvlad Wamamde miRebisa;
o pacientma unda miiRos damatebiTi sakvebis ulufa
diliT adre an gvian saRamos, rodesac stimulantis
moqmedeba minimaluria;
o sakvebi racioni unda iyos maRalklaoriuli,
srulfasovani.

gulis funqciebi da arteriuli wneva (unda gakontroldes bavSvebi,

mozardebi da mozrdilebi)
 gulis riTmi da arteriuli wneva unda gakontroldes yvela
dozis cvlilebisas da 3 TveSi erTxel da dafiqsirdes
centilur CartSi,
 taqikardia mosvenebis dros, ariTmia, da sistoluri wneva 2
jer gazonili 95 percentilze meti (an klinikurad
mniSvnelobani mateba) unda gaxdes eqimTan mimarTvisa da
dozis Semcirebis signali.

41
reproduqciuli sistema da seqsualuri funqcia (unda
gakontroldes mozardebi da mozrdilebi, mxolod atomoqsetinis
miRebis SemTxvevaSi)
 unda moxdes dismenoreis, ereqciuli da eakulaciuri
disfunqciis monitorireba;

gulyrebi (bavSvebi, mozardebi da mozrdelebi – meTilfenidatisa

da atomoqsetinis miRebis SemTxvevaSi)
 Tu aRineniSnebaT gamwvaveba bavSvebs, romelTac hqondaT
epilefsia, an fiqsirdeba axladaRmocenebuli gulyrebi,
medikamenti unda Sewydes dauyovnebliv;
 mesameuli donis specialistTan SeTanxmebiT unda iqnes
ganxiluli deqsamfetaminis daniSvnis sakiTxi.

tikebi (bavSvebi, mozardebi da mozrdilebi – meTilfenidatisa da

deqsamfetaminis miRebis SemTxvevaSi)
 ganixileT, aris Tu ara tiki stimulantiT gamowveluli, da
aris Tu ara tikebiT gamowveluli ziani metad mniSvnelovani,
vidre ADHD-s mkurnaloba;
 Tu tikebi stimulantebiTaa gamowveuli, ganixileT daniSnuli
stimulantis atomoqsetiniT Secvla

fsiqotikuri simptomebi (bodva, halucinacia) (bavSvebi, mozardebi

da mozrdelebi – meTilfenidatisa da deqsamfetaminis miRebis
SemTxvevaSi)
 unda Sewydes medikamenturi mkurnaloba, Catardes sruli
fsiqiatriuli gamokvleva;
 ganixileT atomoqsetinis daniSvnis sakiTxi

SfoTvis simptomebi panikis CaTvliT (bavSvebi, mozardebi da

mozrdelebi – meTilfenidatisa da deqsamfetaminis miRebis
SemTxvevaSi)
 rodesac simptomebi gamowveulia stimulantebiT,
gansakuTrebiT mozrdilebSi, romelTac aReniSnebaT
Tanmxlebi SfoTviTi aSliloba, Semcirebuli unda iqnes doza
da/an kombinirebuli Terapia warimarTos antidepresantTan
erTad, romelic gamoiyeneba SfoTviTi aSlilobisas;

42
  SesaZloa, efeqturi iyos atomoqsetinze gadasvla.

aJitacia, gaRizianebadoba, TviTmkvllobaze fiqri, TviTdaSaveba –

(atomoqsetinis miRebis SemTxvevaSi)
 mWidro monitorireba, gansakuTrebiT mkurnalobis dawyebis
pirvel Tves an dozis momatebis Semdeg;
 atomoqsetinis daniSvnis SemTxvevaSi pacienti an
mSobeli/momvleli unda gafrxilebul iqnes, rom preparatis
erT-erTi gverdiTi movlenaa suicidaluri azrebi,
TviTdaSaveba, rac gansakuTrebiT xSiria mkurnalobis pirveli
kvirebis ganmavlobaSi. nebismieri gamovlenisas aucilebelia
eqimis saqmis kursSi Cayeneba;

7. reabilitacia / meTvalyureoba
meTvalyureoba
aucilebelia daavadebuli bavSvis monitoringi. mSoblebisgan,
maswavleblebisgan da uSualod bavSvisgan miiReba dawvrilebiTi
informacia samizne Sedegebisa da gverdiTi efeqtebis Sesaxeb.
monitoringis sixSire damokidebulia disfunqciis doneze, gar-
Tulebebze, daniSnuli mkurnalobis xasiaTze. bavSvis mdgomareobis
stabilizaciis Semdeg eqimTan 3-6 TveSi erTxel mosvlac sakmarisia.
mizandasaxuli mkurnalobis Sedegad, klinikuri niSnebis
gamoxatuleba asakis matebasTan erTad klebulobs. miuxedavad amisa,
mozardebis 22-85%-sa da mozrdilebis 4-66%-Si diagnozis moxsna
ver xerxdeba77,78

daskvna
amrigad, yuradRebis deficitis/hiperaqtivobis sindromi
warmoadgens saskolo asakis bavSvebSi qronikulad mimdinare
daavadebas, romelic mniSvnelovan zegavlenas axdens socialur
adaptaciasa da akademiur moswrebaze. mkurnalobis gareSe
simptomebi xSirad mozrdilobis asakSic grZeldeba. mkurnaloba
moicavs medikamentur da qceviT Terapias. efeqtis miRebisaTvis
mizanSewonilia samizne Sedegebis moxazva da mkurnalobis dagegm-
vaSi uSualod bavSvis CarTva. aucilebelia pacientis mdgomareobis
mudmivi monitorireba.

43
8. eTikur-samarTlebrivi sakiTxebi
yuradRebis deficitis hiperaqtivobis sindromis marTva da
mkurnaloba pirveladi jandacvis sistemaSi samedicino eTikis
mTavari principebis dacviT unda ganxorcieldes. arsebiTi
mniSvneloba pacientis uflebebis dacvis da gadawyvetilebis
miRebis procesSi mis monawileobas aqvs. bavSvTa asakSi
diagnostirebuli ADHD-s SemTxvevaSi mSoblebs unda miewodoT
sruli informacia daavadebis mimdinareobis, qceviTi Terapiis,
medikamenturi mkurnalobis efeqturobisa da gverdiTi movlenebis
Sesaxeb da isini intensiurad unda iyvnen CarTulni mkurnalobis
procesSi. gansakuTrebiT didi sifrTxiliT unda moxdes diagnozis
dasma, raTa arasworad dasmulma diagnozma uaryofiTi gavlena ar
moaxdinos bavSvis momavalze, meores mxriv, gasaTvaliswinebelia,
rom droulad dawyebuli mkurnaloba exmareba bavSvs da mozards,
marTon yoveldRiuri yofiTi Cvevebi.
aseve, sayuradReboa is faqtic, rom stimulantebiT mkurnalobis
dros SesaZlebelia wamlis aramiznobrivad miReba pacientis, an
ojaxis wevrebis, an megobrebis mier. amis gamo mSoblebisa da
skolis pedagogebis/aRmzrdelebis CarTulobas mkurnalobis
monitorirebis procesSi didi yuradReba unda daeTmos.

9. praqtikaSi adaptaciis da protokolis SemuSavebis

rekomendaciebi
klinikuri praqtikis auditis kriteriumebi
auditis kriteriumebi dafuZnebulia gaidlainis rekomendaciebze
yuradRebis deficitis/hiperaqtivobis sindromis mqone pacientebTan
mimarTebaSi. mocemuli standartebi rogorc wesi an 100%, an 0%. Tu
isini ar aris miRwevadi mokle drois ganmavlobaSi, ufro
Sesaferisi standarti unda dadgindes, adgilobriv klinicistebTan
diskusiebis safuZvelze. Tumca, mocemuli standartebi saboloo
miznad unda darCes.

yuradRebis deficitis/ hiperaqtivobis sindromis auditis

kriteriumebi:
1. pacientTa procentuli raodenoba, visac daudginda
yuradRebis deficitis/ hiperaqtivobis sindromi da
dafiqsirda samedicino CanawerebSi (baraTSi) bolo 12 Tvis
ganmavlobaSi.

44
 2. axalgazrda da mozrdilTa pacientTa procentuli raodenoba,
visac bavSvTa asakidanve daudgindaT yuradRebis deficitis/
hiperaqtivobis sindromi da gaTviTcnobierebuli aqvT
informacia sakuTari mdgomareobis Sesaxeb, bolo 12 Tvis
ganmavlobaSi.
3. pacientTa procentuli raodenoba, romelTac aReniSnebaT
yuradRebis deficitis/ hiperaqtivobis sindromis
diagnostikuri kriteriumebis simptomebi: yuradRebis
deficiti, hiperaqtivoba, an impulsuroba.
4. pacientTa procentuli raodenoba, romelTac CautardaT
fsiqologiuri, socialuri samsaxurebis daxmareba bolo 12
Tvis ganmavlobaSi.
samizne mosaxleoba (pacientTa jgufebi).
Sesabamis pacientTa jgufebs warmoadgenen yuradRebis
deficitis/hiperaqtivobis sindromis mqone bavSvebi, mozrdilebi da
axalgazrdebi.
monacemTa wyaroebi
auditis kriteriumebi SeiZleba moiTxovdes monacenebis Segrovebas
sxvadasxva wyarodan, maT Soris saprogramo dokumentebidan da
pacientTa Sesaxeb arsebuli Canawerebidan.
xelaxali auditi (re-auditi)
miuxedavad imisa, emTxveva Tu ara pacientis Sesaxeb miRebuli
Sedegebi standartebs, xelaxali auditi warmoadgens auditis
ciklis mniSvnelovan nawils. Tu pirveladi monacemebis Segroveba
da analizi gviCvenebs gaumjobesebis SesaZleblobas, maSin unda
SemuSavdes Semdgomi moqmedebaTa gegma. momsaxurebaSi xelaxali
auditis erTjerad cvlilebebs unda mieces dro, raTa maT
gavlena moaxdinon procesze. gamomdinare cvlilebebis bunebisagan
amas SeiZleba ramodenime kvira an Tve dasWirdes. procesi unda
gagrZeldes manam, sanam auditis Sedegebi ar mova SesabamisobaSi
standartebTan. savaraudo drois periodia konsultaciebi 12 Tvis
ganmavlobaSi.

10. gaidlainis miRebis xerxi/wyaro

gaidlaini warmoadgens sxvadasxva gaidlainebis (ix. literatura)
Sejerebis da adaptaciis Sedegs.

45
11. alternatiuli gaidlaini
alternatiuli gaidlaini ar arsebobs.

12. mtkicebulebis done, rekomendaciebis xarisxi

klasi mtkicebuleba

A swori dizainis mqone randomizebuli kontrolirebadi kvleva

B kohortuli kvleva

klinikuri kvleva randomizaciis gareSe, kohortuli da SemTxveva-

C
kontrolis kvlevebi
araeqsperimentuli multicentruli kvlevebi
jvaredini kvleva
D
SemTxvevaTa seria
SemTxvevaTa analizi
meta-analizi
M
sistemuri mimoxilva
klinikuri gamocdileba,
R eqspertTa angariSi,
eqspertTa konsensusi

X avtoritetul profesionalTa mosazreba

46
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“Diagnosis And Management of Attention Deficit Hyperactivity Disorder in Primery
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“Current Strategies in the Diagnosis and Treatment of Childhood Attention-
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Oklahoma, ERIN C. CALLEN, PharmD, Southwestern Oklahoma State University
College of Pharmacy, Weatherford, Oklahoma. Am Fam Physician. 2009;79(8):657-665.
bavSvis fsiqikuri ganviTarebis darRvevebi. Tamar gagoSiZe.
Tbilisi, 2007w.

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14. avtorTa jgufi

klinikuri praqtikis erovnuli rekomendacia (gaidlaini)
momzadda saqarTvelos ojaxis eqimTa asociaciis mier

avtorebi: nino kiknaZe (ojaxis eqimi), eka faRava (ojaxis eqimi),

qeTevan nemsaZe (pediatri), gia meliqiSvili (bavSvTa
nevrologi), guram kiknaZe (redaqtori), givi
javaSvili (redaqtori).
eqspertebi:
 saqarTvelos saojaxo medicinis profesionalTa kavSiri;
 saqarTvelos pediatriis akademia;
 lela woworia _ saqarTvelos Sromis, janmrTelobisa
da socialuri dacvis saministros janmrTelobis dacvis
departamenti;
 Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa
da socialuri dacvis saministros janmrTelobis dacvis
departamenti;
 Tamar ZagniZe _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros janmrTelobis dacvis
departamenti.

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