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Latar belakang: Proses belajar penting bagi seorang anak dalam perkembangannya. Anak dapat belajar dengan baik bila didukung kondisi yang baik pula. Salah satu faktor pendukung tersebut adalah fungsi memori kerja. Penelitian menunjukkan memori kerja merupakan prediktor kapasitas belajar yang lebih bermakna daripada intelligence quotient (IQ). Bila fungsi ini terganggu, anak dapat mengalami kesulitan belajar. Studi melaporkan gangguan memori kerja banyak ditemukan pada gangguan pemusatan perhatian dan hiperaktivitas (GPPH). Oleh karena itu, penelitian ini mencoba mendapatkan data proporsi gangguan memori kerja pada anak GPPH dan perbandingan dengan anak tanpa GPPH. Data ini diharapkan dapat menjadi data dasar bagi pengembangan intervensi selanjutnya.

 

Metode: Penelitian ini dilakukan dengan desain potong lintang pada bulan Mei 2017 hingga Mei 2019. Pengambilan sampel dilakukan dengan metode randomized sampling menggunakan program SPSS. Instrumen Mini International Neuropsychiatry Interview KID (M.I.N.I. KID) digunakan untuk membantu menegakkan 24 diagnosis gangguan jiwa anak dan remaja yang terdapat di DSM-IV dan ICD-10 secara komprehensif dan Working Memory Rating Scale (WMRS) dgunakan untuk menentukan ada tidaknya defisit memori kerja pada anak berusia 5-11 tahun dan telah divalidasi dalam Bahasa Indonesia oleh Wiguna, dkk. (2012).

 

Hasil: Proporsi gangguan memori kerja pada kelompok anak dengan GPPH berbeda bermakna dibandingkan kelompok anak tanpa GPPH (44% vs 0%, p<0,05). Pada uji analisis, didapatkan prevalence ratio (PR) sebesar 40,4 (95%CI 2,22 - 738,01), artinya anak dengan GPPH berisiko mengalami gangguan memori kerja 40,4 kali lebih besar dibandingkan anak tanpa GPPH. Rerata WMRS juga menunjukkan perbedaan yang bermakna antara kelompok subjek dengan GPPH dan kelompok subjek tanpa GPPH [50,48 (SB=11,08) vs 30,60 (SB=8,04), p<0,05] namun tidak berbeda bermakna antara kelompok subjek dengan GPPH yang mengkonsumsi metilfenidat hidroklorida  dan yang tidak mengkonsumsi metilfenidat hidroklorida [50,93 (SB=10,25) vs 50,09 (SB=11,26), p=0,85].

 

Simpulan: Gangguan memori kerja lebih banyak ditemukan pada anak dengan GPPH. Temuan ini sesuai dengan hasil penelitian lainnya. Oleh karena itu, pemeriksaan memori kerja pada anak dengan GPPH sebaiknya dilakukan untuk mengantisipasi kesulitan belajar yang mungkin timbul di kemudian. Intervensi tambahan, seperti game therapy dapat dipertimbangkan untuk memperbaiki gangguan memori kerja yang ditemukan pada anak-anak dengan GPPH.

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Background: Learning process is important in child’s development. Children may learn well if supported by good conditions. One of the supporting factors is working memory. Research shows working memory is more meaningful learning capacity’s predictor than intelligence quotient (IQ). If this function is interrupted, children can experience learning difficulties. Studies reporting working memory impairment often found in attention deficit and hyperactivity disorder (ADHD). Therefore, this study tried to obtain data on the proportion of working memory impairment in ADHD children and its comparison with healthy children. Results is expected to be the basic data for the development of further interventions.

 

Method: This study was conducted in a cross-sectional design in May 2017 to May 2019. Sampling was done by randomized sampling method using the SPSS program. The Mini International Neuropsychiatry KID Interview Instrument (MINI KID) was used to establish 24 diagnoses of child and adolescent mental disorders comprehensively as in the DSM-IV and ICD-10, and the Working Memory Rating Scale (WMRS) was used to determine the presence or absence of working memory deficits in children aged 5-11 years and have been validated in Indonesian by Wiguna et al. (2012).

 

Results: Proportion of working memory impairments in ADHD group was significantly different compared to group without ADHD (44% vs 0%, p <0.05). Analysis test shows children with ADHD were at risk of experiencing working memory impairment 40.4 times greater than children without ADHD (prevalence ratio 40.4, 95% CI 2.22 - 738.01). The average WMRS scores also showed significant difference between group with ADHD and without ADHD [50.48 (SD = 11.08) vs 30.60 (SD = 8.04), p <0.05]

but not significantly different between who consumed and those who did not consume methylphenidate hydrochloride [50.93 (SD = 10.25) vs 50.09 (SD = 11.26), p = 0.85].

 

Conclusions: Working memory disorders are more common in children with ADHD. This finding is in accordance with the results of other studies. Therefore, examination of working memory in children with ADHD should be done to anticipate learning difficulties that may arise later. Additional interventions, such as game therapy, can be considered to improve working memory impairment found in children with ADHD.

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"Latar belakang. Gangguan Pemusatan Perhatian dan Hiperaktif (GPPH) merupakan gangguan psikiatri anak yang paling sering dan 30-40% dari kasus kesehatan mental anak yang dirujuk. GPPH ditandai sulit memusatkan perhatian, hiperaktif, impulsif serta berdampak terhadap emosi, perilaku, psikososial, akademik dan fungsi keluarga. GPPH merupakan gangguan berat karena melibatkan multi aspek yaitu hambatan, kronisitas, morbiditas dan komorbiditas. Puncak usia onset pada usia 3-5 tahun. Penelitian ini untuk memperoleh proporsi GPPH pada anak prasekolah dengan alat ukur SPGPI, membuktikan alat ukur SPGPI, SPRDAP dan SPMP andal dan sahih serta membuktikan riwayat GPPH dalam keluarga dan regulasi diri berhubungan dengan GPPH.Metode. Uji diagnostik untuk alat ukur skala penilaian GPPH prasekolah Indonesia (SPGPI), skala penilaian regulasi diri prasekolah (SPRDAP) dan skala penilaian model pengasuhan (SPMP). Metode pengambilan sampel dengan cara simple random sampling. Subjek adalah anak berusia 3 - < 7 tahun pada 34 kelompok bermain dan taman kanak-kanak di DKI Jakarta, bulan Maret-Juni 2009. Seribu subjek untuk penelitian uji diagnostik dan 750 subjek untuk potong lintang. Alat ukur yang dibuat pada penelitian pertama diterapkan pada penelitian kedua.Hasil. Uji diagnostik SPGPI mempunyai Cronbach coefficient alpha 0,996, sensitivitas 96%, spesifisitas 99%, titik potong 30 dan area di bawah kurva ROC 0,9774. SPRDAP mempunyai Cronbach coefficient alpha 0,937, sensitivitas 92%, spesifisitas 96%, titik potong 20 dan area di bawah kurva ROC 0,9383. SPMP mempunyai Cronbach coefficient alpha 0,8125, sensitivitas 72%, spesifisitas 95%, titik potong 70, dan area di bawah kurva ROC 0,8233. Faktor risiko ayah perokok RP 3,48(1,79 sampai 6,78), regulasi diri RP 21,01(6,98 sampai 63,28), riwayat GPPH dalam keluarga RP 11,89 (2,44 sampai 44,65).Simpulan. SPGPI, SPRDAP dan SPMP adalah andal dan sahih untuk digunakan sebagai alat ukur. Faktor-faktor yang berhubungan bermakna dengan GPPH anak prasekolah adalah ayah perokok, regulasi diri dan riwayat GPPH dalam keluarga.

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Background. Attention deficit hyperactivity disorder (ADHD) is the most common child psychiatric disorder, comprising 30-40% child mental health cases referred. ADHD is typically characterized by inattention, hyperactivity and impulsivity and affects the emotion, behavior, psychosocial, academic and family functioning. ADHD is a severe disorder includes the impairment, chronicity, morbidity and comorbity. The peak of onset is 3-5 years. This study aims to obtaining the proportion of ADHD in preschool children with SPGPI instrument, to demonstrate SPRDAP and SPMP instrument are reliable and valid, and to demonstrate ADHD related to family history and self regulation.

Methods. Diagnostic test for SPGPI, SPRDAP and SPMP Instruments. This study using questionnaire and interview. Sampling method was simple random sampling. Participant from 34 playgroup and kindergarten were selected from DKI Jakarta. The study was conducted from March-June 2009. The samples were 1000 for diagnostic test and 750 for cross sectional study and the children age from 3 - < 7 years were selected. Parents and teachers of these children were asked to complete SPGPI, SPRDAP, SPMP and personal form. The instruments from first study were applied for the second study.

Result. The result on diagnostic test showed that the Cronbach coefficient alpha 0.996, sensitivity 96%, specificity 99% for SPGPI, cut off point 30 and area under ROC curve 0.9774. For SPRDAP instrument, the Cronbach coefficient alpha 0.937, sensitivity 92%, specificity 96%, cut off point 20 and area under ROC curve 0.9383. For SPMP instrument, the Cronbach coefficient alpha 0.8125, sensitivity 72%, specificity 95%, titik potong 70 dan area under ROC curve 0.8233. The related factors were patemal smoking PR 3.48 (1.79 to 6.78), self regulation PR 21.01 (6.98 to 63.28) and family history PR 11.89 (2.44 to 44.65).

Conclusion SPGPI, SPRDAP and SPMP is reliable and valid and used as an instrument. Patemal smoking, self regulation, family history of ADHD were related to ADHD."

"[ABSTRAKTesis ini membahas refleks primitif pada anak usia 4-12 tahun dengan gangguan pemusatan perhatian dan hiperaktivitas (GPPH) dan tanpa GPPH serta faktor-faktor yang memengaruhinya. Penelitian ini bersifat deskriptif dimana refleks yang dinilai adalah refleks Moro, asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), tonic labyrinthe reflex (TLR), dan spinal Galant. Hasil yang ditemukan adalah banyak anak dengan GPPH ditemukan refleks primitif, terutama ATNR. Faktor-faktor yang mempengaruhi GPPH adalah pendidikan orangtua, pekerjaan ayah, pola asuh, kemiskinan, kesehatan ibu saat mengandung, dan paparan rokok. Diharapkan refleks primitif dijadikan sebagai pemeriksaan rutin pada anak sebelum memasuki usia sekolah.

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ABSTRACTFocus of the study was to describe primitive reflexes in 4-12 years old children with and without attention deficit hyperactivity disorder (ADHD) and influenced factors in ADHD emerging. It was descriptive research. Five reflexes were valued that were oro refex, asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), tonic labyrinthe reflex (TLR), dan spinal Galant. Results noted primitive reflexes could be found in ADHD, mainly ATNR. Parent?s education, father?s occupation, parenting, poverty, mother?s health in pregnancy, cigarette?s exposure related to persistence of primitive reflexes. We recommend primitive reflexes should be early physical assessment in children before entry school age, Focus of the study was to describe primitive reflexes in 4-12 years old children with and without attention deficit hyperactivity disorder (ADHD) and influenced factors in ADHD emerging. It was descriptive research. Five reflexes were valued that were oro refex, asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), tonic labyrinthe reflex (TLR), dan spinal Galant. Results noted primitive reflexes could be found in ADHD, mainly ATNR. Parent’s education, father’s occupation, parenting, poverty, mother’s health in pregnancy, cigarette’s exposure related to persistence of primitive reflexes. We recommend primitive reflexes should be early physical assessment in children before entry school age]"

"[Kemampuan untuk mempertahankan perhatian merupakan masalah bagi anak dengan gangguan atensi dan hiperaktivitas. Latihan pemusatan perhatian dengan latihan fisik mampu meningkatkan rentang perhatian pada anak dengan gangguan atensi dan hiperaktivitas serta efeknya cenderung bertahan lama. Sedangkan intervensi dengan kegiatan membaca juga terbukti mampu meningkatkan rentang perhatian namun efeknya cenderung menghilang setelah intervensi tidak diberikan lagi. Penelitian ini menggunakan desain penelitian eksperimen (N=15), yang bertujuan untuk membandingkan efektivitas latihan fisik dan kegiatan membaca dalam meningkatkan rentang perhatian pada anak dengan gangguan atensi dan hiperaktivitas. Peningkatan rentang perhatian diukurketika anak membaca dengan teknik observasi menggunakan perhitungan waktu dalam detik. Penelitian ini juga menggunakan pengukuran gejala gangguan atensi dan hiperaktivitas dengan alat ukur Vanderbilt ADHD Rating Scale.;The ability to maintain attention is a problem for children with attention and hyperactivity disorder. Attention exercise with physical exercise can increase attention span in children with attention and hyperactivity disorder, and the effectsof these intervention was durable. While attention exercise with reading activity can also increase attention span, but the effect tends to disappear after the intervention was not continue. This research used an experimental design (N = 15), which aims to compare the effectiveness of physical exercise and reading activitiy to increase attention span in children with attention and hyperactivity disorder. The attention span is measured when the children read by observationtechniques using a calculation time in seconds. This study also use themeasurement of attention and hyperactivity symptoms with Vanderbilt ADHD Rating Scale., The ability to maintain attention is a problem for children with attentionand hyperactivity disorder. Attention exercise with physical exercise can increaseattention span in children with attention and hyperactivity disorder, and the effectsof these intervention was durable. While attention exercise with reading activitycan also increase attention span, but the effect tends to disappear after theintervention was not continue. This research used an experimental design (N =15), which aims to compare the effectiveness of physical exercise and readingactivitiy to increase attention span in children with attention and hyperactivitydisorder. The attention span is measured when the children read by observationtechniques using a calculation time in seconds. This study also use themeasurement of attention and hyperactivity symptoms with Vanderbilt ADHDRating Scale.]"