注意缺陷多动障碍患儿748例各亚型的临床特点  

Clinical features of the subtypes of attention deficit hyperactivity disorder in 748 Chinese children

作　　者：钱秋谨[1] 杨莉[1] 王玉凤[1] 

机构地区：[1]北京大学精神卫生研究所,100083

出　　处：《中国实用儿科杂志》2005年第9期530-533,共4页Chinese Journal of Practical Pediatrics

基　　金：卫生部临床学科重点项目(2004)

摘　　要：目的比较美国《精神障碍诊断与统计手册》第4版(DSM-Ⅳ)注意缺陷多动障碍(ADHD)中以注意障碍为主型(ADHD-I)、以多动/冲动为主型(ADHD-HI)和混合型(ADHD-C)的临床特点。方法将1999年9月至2004年4月北京大学精神卫生研究所门诊就诊的符合DSM-Ⅳ中的ADHD诊断标准者748例分为ADHD-I型398例,ADHD-C亚型307例和ADHD-HI亚型43例,比较3个亚型的共患疾病,以及Rutter和Conners儿童行为问卷(父母问卷)中的行为问题。结果ADHD-C亚型对立违抗性障碍、品行障碍、双相障碍-躁狂发作的共患率显著高于ADHD-I和ADHD-HI亚型(P<0·01);ADHD-I学习困难的共患率显著高于其它两组亚型(P<0·001)。Rutter儿童行为问卷中ADHD-C亚型伴有的总行为问题和A行为问题明显多于ADHD-I与ADHD-HI亚型;ADHD-I亚型伴有的M行为问题多于ADHD-C与ADHD-HI亚型(P≤0·001)。Conners儿童行为问卷中ADHD-C和ADHD-HI亚型出现品行问题、冲动和多动、多动指数问题的比例均高于ADHD-I亚型(P≤0·001)。结论ADHD-C亚型的破坏性行为问题突出,而ADHD-I亚型的学习困难问题明显。Objective To explore the features of three clinical subtypes of attention deficit hyperactivity disorder （ADHD ） in Chinese outpatient children. Methods Using DSM-Ⅳ Structured Clinical Diagnostic Interview Scale （CDIS） ,the 748 ADHD children were clascified into three subtypes,and identified 398 ADHD-Ⅰ,307 ADHD-C,and 43 ADHD-HI. We compared the comorbidities in CDIS, the behavioral problems in Rutter and Conners Child Behavior Questionnaire completed by the parents among ADHD three subtypes. Results For ADHD-C subtype,the frequencies of comorbidity with disruptive behavior disorder （ oppositional defiant disorder and conduct disorder） and bipolar disorder,and the frequency of A-type behavior in Rutter＇s scale,were higher than those in the ADHD-I and ADHD-HI subtypes （ P 〈 0. 01 ）. For ADHD-Ⅰ subtype,the frequencies of comorhidity with learning disability and M-type behavior in Rutter＇s scale, were significantly higher than those in the ADHD-C and ADHD-HI subtypes （ P 〈 0. 001 ）. The frequencies of conduct prohlems,implusive-hyperactive,and hyperactivity index in ADHD-C and ADHD-HI were greater than that in ADHD-Ⅰ subtype（ P ≤0.001 ） Conclusion There is a higher prevalence of comorbid disruptive behavior disorders in the ADHD- C subtype,hut there is a higher prevalence of comorbid learning disability in the ADHD-Ⅰ subtype.

关 键 词：注意缺陷多动障碍 亚型 共患病 行为问题 

分 类 号：R72[医药卫生—儿科]