学龄前儿童注意缺陷多动障碍共患对立违抗障碍执行功能的研究  

Research on executive function of attention-deficit/hyperactivity disorder comorbidity with oppositional defiant disorder in preschool children

作　　者：潘景雪 张劲松[1] 帅澜[1] 张慧凤[1] 路腾飞[1] Pan Jingxue;Zhang Jinsong;Shuai Lan;Zhang Huifeng;Lu Tengfei.(Department of Medical Psychology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Ministry of Education and Shanghai Key Laboratory of Children＇s Environmental Health, Shanghai 200092, Chin)

机构地区：[1]上海交通大学医学院附属新华医院临床心理科教育部和上海市环境与儿童健康重点实验室,200092

出　　处：《中华精神科杂志》2018年第3期182-187,共6页Chinese Journal of Psychiatry

基　　金：上海市科学技术委员会科研计划项目（14411968600）

摘　　要：目的 探讨学龄前儿童注意缺陷多动障碍（attention-deficit/hyperactivity disorder,ADHD）及共患对立违抗障碍（oppositional defiant disorder,ODD）儿童执行功能情况,分析ADHD症状和ODD症状与执行功能的关系.方法 纳入符合DSM-5和婴幼儿诊断性访谈ADHD和ODD诊断标准的患儿234例,其中单纯ADHD191例（ADHD组）,ADHD共患ODD43例（ADHD＋ODD组）以及105名健康儿童（对照组）,采用学龄前儿童执行功能行为评定问卷（父母版）（Behavior Rating Scale of Executive Function-Preschool Version,BRIEF-P）及中文版注意缺陷多动障碍SNAP-Ⅳ评定量表-父母版（Chinese Version of Swanson Nolan and Pelham,Version Ⅳ Scale-parent Form,SNAP-Ⅳ）评估学龄前儿童的执行功能、ADHD症状和ODD症状,使用协方差和偏相关分析ADHD症状、ODD症状与执行功能的关系.结果 学龄前ADHD共病ODD比率为18.4％（43/234）,其中男36例占18.6％,女7例占17.5％,男女共患ODD的比率差异无统计学意义（x2=0.03,P＞0.05）.3组年龄差异无统计学意义,性别（x2=22.33,P＜0.01）与总智商（F=15.87,P＜0.05）差异有统计学意义;控制性别、智商和注意缺陷及多动冲动得分,3组之间BRIEF-P中除工作记忆和元认知指数因子外,其余各因子及总分ADHD＋ODD组高于ADHD组,差异有统计学意义;ODD症状与BRIEF-P各因子得分和总分,除工作记忆外呈低至中度相关（r=0.11 ～ 0.49,均P＜0.01）.控制智商、性别和ODD症状后,ADHD症状与BRIEF-P各因子得分和总分呈中至高度相关（r=0.16～ 0.70,均P＜0.01）.结论 学龄前单纯ADHD及共患ODD儿童的执行功能均受损,且共患ODD儿童执行功能受损程度较单纯ADHD儿童更严重.学龄前儿童ADHD症状和ODD症状与执行功能具有明显的相关性.Objective To investigate the executive function of preschoolers with attention-deficit/ hyperactivity disorder（ADHD）,and comorbid of oppositional defiant disorder （ODD）,and analyze the correlation between executive function and ADHD,executive function and ODD symptom.Methods The 234 ADHD preschool children enrolled in this study,aged 4y0m-5y11 m（including 191 children with ADHD and 43 with ADHD＋ ODD）,met both the clinical diagnosis with DSM-5 criteria and the interview diagnosis by Diagnostic Infant and Preschool Assessment.Total of 115 healthy normal children with the similar age to the ADHD children were as control.Behavior Rating Scale of Executive Function-Preschool Version （BRIEF-P） and Chinese Version of Swanson Nolan and Pelham,Version Ⅳ Scale-parent Form （SNAP-Ⅳ）were used to evaluate executive function,symptoms of ADHD and ODD respectively.Covariance and partial correlation analysis were applied to explore the relation between executive function and symptoms of ADHD and ODD.Results The comorbidity rate of ADHD with ODD among preschoolers in this research was 18.4% （43/234）,no significant difference was found between two genders （18.6% and 17.5% in boys and girls respectively,x2=0.03,P〉0.05）.There was no significant difference in the age among the three groups.There were significant differences in gender （x2=22.33,P〈0.01）and intelligence quotient （IQ;F=15.87,P〈0.05） among the three groups.After the gender,IQ and scores of inattention and hyperactivity were controlled,domains of BRIEF-P （except for working memory and metacognition index） among ADHD＋ODD children were significantly higher than those in ADHD children （all P〈0.01）.Besides,partial correlation analysis showed a positive correlation between ODD symptom and executive function （except for working memory;r=0.11-0.49,all P〈0.01）.The correlation was still positive between ADHD symptom and executive function when gender,IQ and ODD symptom were statistically controlled （r=0.16-0.70,all P

关 键 词：儿童 学龄前 注意缺陷和分裂性行为障碍 执行功能 

分 类 号：R749.94[医药卫生—神经病学与精神病学]