困难问卷在注意力缺陷多动障碍学龄儿童中应用的病例对照研究  

Application of Questionnaire Children with Difficulties for school aged children with attention deficit/hyperactivity disorder:a case control study

作　　者：梁颖[1] 李楠[1] 袁嘉嵘[1] 付莹[1] 刘烨 Liang Ying;Li Nan;Yuan Jiarong;Fu Ying;Liu Ye(Tianjin Women's and Children's Health Center,Tianjin 300070,China)

机构地区：[1]天津市妇女儿童保健中心,300070

出　　处：《中国中西医结合急救杂志》2019年第6期723-726,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的比较注意力缺陷与健康学龄儿童在一大内不同时间段所面临困难的差异,并评估儿童困难问卷(QCD)与注意力缺陷多动障碍(ADHD)诊断的相关性.方法选择天津市妇女儿童保健中心2017年6月1日至2019年5月31日收治的符合ADHD诊断巨未治疗的患儿212例为ADHD组;并选择同期性别相同、年龄相似的212名健康体检儿童作为对照组.比较两组QCD评分的差异;采用Cronbachα分析评价QCD的内部信度一致性;采用Pearson相关分析法分析QCD与SNAP-Ⅳ量表各因子的相关性.结果212例ADHD患儿平均年龄(8.96±1.59)岁,混合型的例数最多(85例,占40.0%);共病发生比例为37.3%(79例),以学习困难、睡眠问题和对立违抗为主.ADHD组患儿QCD总分及各因子评分(分)均明显低于对照组[QCD总分(分):31.8±9.3比44.3±10.2,早上(Q1~4)为6.2±3.3比8.1±3.2,学校(Q5~7)为5.2±2.0比7.6±1.7,放学后(Q8~10)为6.0±2.2比7.4±1.8,傍晚(Q11~14)为6.4±2.3比7.5±1.8,夜晚(Q15~18)为5.0±2.6比7.4±1.8,总体行为(Q19~20)为2.9±1.4比4.2±1.4,均P<0.01].Cronbachα系数为0.919,说明QCD各项目内部一致性良好.相关性分析显示,QCD与SNAP-Ⅳ量表各项因子均有明显相关性(均P<0.01),其中学校时段和傍晚作业时段与SNAP-Ⅳ量表的注意力缺陷因子相关性较高(r值分别为-0.442和-0.453),傍晚作业时段和夜晚睡前时段与SNAP-Ⅳ量表的多动、冲动因子相关性较高(r值分别为-0.604和-0.526),学校时段、傍晚作业时段与SNAP-Ⅳ量表的对立违抗因子(r值分别为-0.545和-0.539)及量表总分(r值分别为-0.619和-0.683)相关性最显著.结论QCD着眼于ADHD儿童一大内不同时段面临的困难,与ADHD诊断的相关性良好,在门诊中应用简单易行.Objective To compare the difference in experiencing difficulties at different times in a day between the school aged children with attention deficit and healthy children,and evaluate the correlation between Questionnaire Children with Difficulties(QCD)and the diagnosis of deficit/hyperactivity disorder(ADHD).Methods Two hundred and twelve outpatients aged 6-11 years with the diagnosis of ADHD but without treatment were enrolled from June 1,2017 to May 31,2019 in Tianjin Women's and Children's Health Center as an ADHD group;at the same period,212 healthy children matched with the same sex and ages were enrolled as a control group.The differences in QCD scores between the two groups were compared;the evaluation of consistency in internal reliability of the QCD scores was examined by Cronbachαanalysis;Pearson correlation coefficient was calculated to analyze whether QCD score and sub-scores correlated with Swanson,Nolan and Pelham Rating ScaleⅣ(SNAP-Ⅳ)scores.Results The average age of 212 cases in ADHD group was(8.96±1.59)years and the majority of them were males.40.0%(85 cases)was combined ADHD subtypes and the comorbidity rate was 37.3%(79 cases),with learning difficulties,sleep problems and oppositional defiance as the main causes.The total QCD scores and scores of various factors in ADHD group were significantly lower than those in control group[total score:31.8±9.3 vs.44.3±10.2,early morning/before going to school(Q1-4)6.2±3.3 vs.8.1±3.2,school(Q5-7)5.2±2.0 vs.7.6±1.7,after school(Q8-10)6.0±2.2 vs.7.4±1.8,evening(Q11-14)6.4±2.3 vs.7.5±1.8,night(Q15-18)5.0±2.6 vs.7.4±1.8,overall behavior(Q19-20)2.9±1.4 vs.4.2±1.4,all P<0.01].Cronbachαfor QCD was 0.919,indicating good internal consistency of the items(Qs)in the scale.The correlation analysis showed that all correlations were significant between various QCD scores and SNAP-Ⅳscores(all P<0.01).Among the different time segments in a day,the correlations of"school"and"evening"subscores with SNAP-Ⅳattention deficit factor were relatively stron

关 键 词：儿童困难问卷 注意力缺陷多动障碍 儿童 

分 类 号：R74[医药卫生—神经病学与精神病学]