Cosa si cela dietro alla co-occorrenza tra dislessia evolutiva e adhd? (3)

La Dislessia Evolutiva sembra co-occorrere frequentemente con il Disturbo di Attenzione e Iperattività. Quali sono le ipotesi che spiegano questo fenomeno?

ID Articolo: 115472 - Pubblicato il: 16 novembre 2015
Cosa si cela dietro alla co-occorrenza tra dislessia evolutiva e adhd?
Messaggio pubblicitario SFU 2020
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Molti fattori di rischio ambientale sono stati riscontrati associati all’ADHD, ma è stato più difficile comprendere quale di questi possa avere un ruolo causale (Rutter, 2009; Lahey et al., 2009; Thapar et al., 2009). I fattori di rischio maggiormente studiati in relazione all’ADHD sono i fattori pre e peri natali, il fumo in gravidanza (Langley et al., 2005), alcool e l’abuso di sostanze (Linnet et al., 2003), lo stress materno (Glover, 2011; Grizenko et al., 2008), basso peso alla nascita e prematurità (Bhutta et al., 2002); ambienti tossici (Thapar et al., 2013); fattori dietetici (Thapar et al., 2013); caratteristiche socio-culturali dell’ambiente di crescita (Scahill et al., 1999; Pheula et al., 2011).

Tuttavia, molti di fattori ambientali non sono considerati specifici per l’ADHD o per la Dislessia Evolutiva. Questi due disturbi mostrano una sovrapposizione dei fattori di rischio ambientali che può contribuire al co-occorrere dei due disturbi: la chiave per comprendere meglio l’effetto di questi fattori sulla patologia può essere rappresentata da un modello più complesso: l’interazione gene-ambiente (GxE – Nigg et al., 2010).

L’ipotesi che guida questo approccio dichiara che i geni e l’ambiente non operano indipendentemente l’uno dall’altro (Nigg et al., 2010). I fattori di rischio, di qualunque tipo, possono contribuire non solo direttamente ma anche in interazione tra di loro, incrementando la suscettibilità alle avversità ambientali e alterando la sensibilità ai fattori di rischio (Thapar et al., 2013). Un’interazione di questo tipo comporta dunque che una certa suscettibilità genetica sia modulata da misure ambientali (Rutter et al., 2006).

Nonostante la potenziale importanza di questo approccio di interazione gene-ambiente (Rutter et al., 2006), pochi studi hanno preso in considerazione il ruolo congiunto dei marcatori genetici e dei fattori ambientali di rischio. Per quanto riguarda la Dislessia Evolutiva sono stati eseguiti due studi (McGrath et all., 2007; Pennington et al., 2009) che selezionano un campione di bambini con Speech Sound Disorder (SSD), considerati bambini a rischio di Dislessia Evolutiva (Gallagher et al., 2000; Pennington et al., 2001; Raitano et al., 2004). Gli autori trovano un trend d’interazione tra due regioni cromosomiche (6p22 e 15q21) e alcune misurazioni ambientali (e.g., grado di istruzione della madre e la lettura da parte dei genitori al bambino) con effetti su disturbi legati alla lettura (e.g., consapevolezza fonologica, denominazione rapida).

Messaggio pubblicitario Un solo studio (Mascheretti et al., 2013) ha indagato l’interazione gene-ambiente in un campione di bambini con Dislessia Evolutiva e dei loro fratelli. Si è riscontrata un’interazione tra specifici moderatori ambientali (i.e. fumo materno in gravidanza, basso peso alla nascita e basso stato socio economico) e il gene “di rischio” DYX1C1-1259C/G. Più numerosi sono invece gli studi che indagano l’interazione GxE nei bambini con ADHD. Alcune ricerche hanno esaminato il ruolo dell’allele di rischio DAT1 e DRD4 e trovato interazioni significative con l’esposizione prenatale all’alcool e al fumo e l’esposizione ad avversità psicosociali (Kahn, et al., 2003; Brookes et al., 2006; Neuman et al., 2007; Laucht et al., 2007). Retz e colleghi (2008) hanno riscontrato un’interazione G×E tra avversità ambientali dell’infanzia (e.g., stato economico della famiglia, qualità dell’educazione scolastica, grado di conflitto familiare) e il gene 5-HTTLPR. Lasky-Su e colleghi (2007) hanno indagato l’interazione tra il marcatore BDNF in bassi livelli di stato socio-economico. Waldman (2007) esplora la relazione tra il recettore dopaminergico DRD2 e la stabilità matrimoniale.

Non sono presenti, ad oggi, studi che prendono in considerazione popolazioni di bambini affetti sia da Dislessia Evolutiva che da ADHD in cui sia stato indagato un modello di interazione GxG o GxE.

Quello che è possibile concludere da questo breve stato dell’arte è che il modello eziologico necessario per spiegare un disturbo del neurosviluppo è altamente complesso e polifattoriale, ovvero composto da diversi fattori genetici ed ambientali (Faraone et al., 1999; Fisher et al., 2002). Di conseguenza, per essere in grado di spiegare la co-occorrenza tra due disturbi è necessario un modello almeno altrettanto complesso. Sarà quindi importante approfondire quale ipotesi spieghi al meglio tale co-occorrenza, tuttora ancora parzialmente sconosciuta, per approfondire la conoscenza dei fattori di rischio e per permettere lo sviluppo di sempre più accurate tecniche di prevenzione.

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Disturbi specifici dell'apprendimento: aspetti emotivi e comorbilità

Oltre i processi cognitivi negli alunni con DSA, importanti sono i fattori emotivi che possono incidere sullo sviluppo creando disagio o disturbo mentale. %%page%%

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