对立违抗性障碍、注意缺陷多动障碍儿童的冲动行为及社会心理因素  

Impulsive behaviors and psychosocial factors in children with oppositional defiant disorder and attention-deficit /hyperactivity disorder

作　　者：王长虹[1,2] 苏林雁[2] 李晏[3] 耿耀国[4] 徐该玲[1] 从恩朝[1] 聂慧瑶[1] 

机构地区：[1]新乡医学院第二附属医院临床精神卫生教研室,河南新乡453002 [2]中南大学湘雅二院精研所,长沙410011 [3]郑州大学公共卫生学院,郑州450001 [4]郑州大学教育学院心理学系,郑州450001

出　　处：《中国心理卫生杂志》2012年第6期424-428,共5页Chinese Mental Health Journal

基　　金：国家自然科学基金(30370521);卫生部科研项目(20090103);河南省教育厅自然科学研究计划项目(2009A320012)

摘　　要：目的:探讨对立违抗性障碍(ODD)、注意缺陷多动障碍(ADHD)及二者共病儿童的冲动行为与心理社会因素的关系。方法:以152例正常儿童为对照组,以157例符合美国精神障碍诊断与统计手册第4版Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-IV)的ODD、ADHD、ODD合并ADHD,且Barratt冲动量表平均量表分≥正常组均值1.5个标准差的儿童为病例组,采用父母养育方式评价量表(EMBU)、家庭功能评定(FAD)、3～7岁儿童气质问卷(BSQ)、8～12岁儿童气质问卷(MCTQ)、儿童自我意识量表(PHCSS)、自尊调查量表(SEI)及Conners教师问卷(TRS)进行测查。结果:病例组EMBU父母情感温暖及理解得分低于对照组,惩罚及严厉、拒绝及否认得分高于对照组(均P<0.05)。病例组FAD的情感介入、行为控制和总功能分值高于对照组(均P<0.05)。病例组气质问卷的活动水平、节律性、反应强度、心境特征、持久性、注意分散维度分值高于对照组,病例组气质类型为麻烦型及中间近麻烦型的比例高于对照组(均P<0.05)。病例组SEI总分低于对照组,Conners教师问卷的品行问题、多动、注意不集中-被动及多动指数高于对照组(均P<0.05)。回归分析显示,夫妻关系差(OR=4.69)、父亲对儿童缺乏情感温暖及理解的养育方式(OR=1.06)、对新环境的适应能力差(OR=2.60)、对新刺激的反应阈值低(OR=2.75)及注意不集中(OR=3.60)可能是儿童发生冲动行为的危险因素;母亲的否认及拒绝少(OR=0.90)、运动冲动性弱(OR=0.83)、活动水平低(OR=0.19)、反应强度弱(OR=0.38)、多动指数低(OR=0.15)、问题解决好(OR=0.38)和情感介入少(OR=0.20)可能是儿童冲动行为的保护因素(P<0.05)。结论:研究提示有冲动行为的ODD、ADHD儿童可能存在自尊程度较低、父母养育方式不良及家庭功能紊乱等社会心理因素。Objectives： To explore the relationship between impulsive behaviors and psychosocial factors in children with oppositional defiant disorder （ODD） and attention-deficit/hyperactivity disorder （ADHD）. Methods： Totally 152 normal children and 157 impulsive children who were diagnosed as ODD and ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-1V） and whose average （Barratt Im- pulsiveness Scale, BIS） score was ≥ 1.5 times the standard deviation of the normal group＇ mean value. They were assessed with the Egm Minnen av Bardnosnauppforstran （EMBU）, Family Assessment Device （FAD）, Behavioral Style Questionnaire （BSQ）, Middle Childhood Temperament Questionnaire （MCTQ）, Piers- Harris Children＇s Self- concept Scale （PHCSS）, Self-esteem Inventory （SEI） and Teacher Rating Scale （TRS）. Results： The EMBU ＂af- fect warmth of father and mother ＂ factor scores were lower in the case group than in the control group （Ps 〈0. 05）. The EMBU ＂punishment and refusal of father and mother ＂factor scores were higher in the case group than in the control group （Ps 〈 0. 05）. The FAD ＂affective involvement＂,＂ behavior control＂ and ＂general functio- ning＂ scores were higher in the case group than in the control group （ Ps 〈 0. 05）. The temperament questionnaire ＂activity level＂, ＂rhythmicity＂, ＂intensity of reaction＂,＂ feature of mood＂,＂ persistency＂, and ＂attention-dispersal＂ scores were higher in the case group than in the control group （Ps 〈0. 05）. Most children＇s temperament in case group were difficulty （D） and intermediate-difficulty （I-D） type, and there were significant differences between case group and control group （Ps 〈0. 01）. The SEI total scores were significantly lower in the case group than in the control group （ P 〈 0. 05）. The scores of TRS ＂conduct ＂, ＂hyperactivity＂, ＂impaired concentration＂ and ＂pas- sive＂, and ＂h

关 键 词：儿童 冲动行为 心理社会因素 

分 类 号：R749.94[医药卫生—神经病学与精神病学]