Implikacije istraživanja bioloških faktora za prevenciju i tretman poremećaja ponašanja

Abstract

Tokom protekle dve decenije povećano je interesovanje za biološke faktore poremećaja ponašanja u detinjstvu i adolescenciji. Cilj rada je da se omogući sistematski pregled savremenih studija ove problematike i ukaže na implikacije njihovih nalaza za prevenciju i tretman. Dosadašnja istraživanja sugerišu da genetski uticaji, prenatalne i perinatalne komplikacije, slaba pobudljivost autonomnog nervnog sistema, strukturalna i funkcionalna oštećenja mozga, hormoni, neurotransmiteri i drugi biološki faktori imaju važnu ulogu u razvoju poremećaja ponašanja. Studije bihejvioralne genetike otkrivaju da se 50–60% individualnih razlika u antisocijalnom i agresivnom ponašanju može pripisati genetskim uticajima. Međutim, mehanizmi putem kojih biološki faktori mogu dovesti do poremećaja ponašanja uglavnom nisu poznati. Postojeći podaci ukazuju da su ove veze složene, indirektne i pod uticajem socijalnog konteksta. Napredak saznanja o biologiji poremećaja ponašanja uticao je na praksu u ovoj oblasti. Na primer, neki fiziološki biomarkeri se koriste kao pomoć u dijagnostici, dok se terapija lekovima, zdravstveno obrazovanje, dijeta i fizičke vežbe koriste za promenu uticaja bioloških faktora. Specijalni pedagozi poznaju rizične faktore koji deluju u porodici, vršnjačkoj grupi, školi, susedstvu i na širem društvenom nivou, ali su slabije informisani o biološkim osnovama poremećaja ponašanja. Integracija nalaza bioloških istraživanja može predstavljati važan korak u razumevanju etiologije poremećaja ponašanja i ustanovljavanju programa prevencije i tretmana koji su multikomponentni i usmereni na specifične potrebe dece i adolescenata sa poremećajem ponašanja.

In the past two decades, there is increasing interest in biological factors for conduct disorder in childhood and adolescence. The purpose of the present paper is to provide a systematic review of contemporary studies on this issue and to highlight the implications of these findings for prevention and treatment. Previous research suggested that genetic influences, prenatal and perinatal complications, underarousal of the autonomic nervous system, structural and functional impairments of the brain, hormones, neurotransmitters and other biological factors play an important role in the development of conduct disorders. Behavioral genetic studies revealed that 50–60% of the variance in antisocial and aggressive behavior is attributable to genetic influences. However, the mechanisms by which biological factors may lead to conduct disorders remain largely unknown. Existing evidence indicates that these relationships are complex, indirect and influenced by social context. Advances in knowledge of the biology of conduct disorders has affected the practice in this field. For example, some physiological biomarkers are used as an aid in the diagnosis, while drug therapy, health education, diet and physical exercise are used to alter the influence of biological factors. Special educators are acquainted with family, peer, school, neighborhood and broader social level risk factors, but less informed about the biological basis of conduct disorders. Integration of the findings from biological research might be an important step in understanding the etiology of conduct disorders and establishing prevention and treatment programs that are multicomponent and tailored to the specific needs of children and adolescents with conduct disorders.