医校家结合方案治疗注意力缺陷多动障碍的非随机对照试验  

The medical-family-school cooperation model for children with attention deficit hyperactivity disorder:A non-randomized controlled trial

作　　者：李瑜 李梦瑶 王胤 徐贇佳 吴芷蘅 朱大倩 LI Yu;LI Mengyao;WANG Yin;XU Yunjia;WU Zhiheng;ZHU Daqian(Department of Psychology,Children's Hospital of Fudan University,National Children's Medical Center,Shanghai 201102,China;Clinical Test Center ofPediatrics Research Institute,Children's Hospital of Fudan University,National Children's Medical Center,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院心理科,上海201102 [2]复旦大学附属儿科医院儿科研究院临床试验中心,上海201102

出　　处：《中国循证儿科杂志》2022年第6期457-462,共6页Chinese Journal of Evidence Based Pediatrics

基　　金：上海市卫健委老龄化和妇儿健康研究专项:2020YJZX0211;上海市卫生健康系统重要薄弱学科项目:2019ZB0203;上海市医学引导类(中、西医)科技支撑项目:19401931200。

摘　　要：背景注意力缺陷多动障碍(ADHD)的治疗强调多模式治疗,我国缺乏医校家结合的分工合作、可操作化强的长效综合干预方式。目的探讨医校家结合模式对ADHD患儿注意力核心症状和家校学习生活功能的影响。设计非随机对照试验。方法干预组实施医校家联合训练方案,基于ADHD医校家长效管理模式及信息平台筛选阳性者并确诊的6~10岁的ADHD患儿;对照组为心理科门诊常规ADHD干预病例,与干预组纳入病例按1∶2进行匹配。2组干预持续4个月,干预期间药物治疗不受限制。主要结局指标中文SNAP-Ⅳ父母版量表评分(注意缺陷、多动/冲动和对立违拗)的变化情况。结果干预组(n=27)和对照组(n=54)ADHD患儿,年龄、干预前使用药物比例、父母年龄、母亲文化程度、家庭收入差异均无统计学意义,智商差异有统计学意义。干预组干预前后SNAP-Ⅳ3个分量表评分均降低≥2分,对照组干预前后SNAP-Ⅳ注意力和多动/冲动分量表评分均降低≥2分;干预组较对照组干预前后对立违拗评分减分值差异有统计学意义。2组干预前后WEISS功能缺陷父母版量表(WFIRS-P)全部6个分量表减分值差异均无统计学意义,其中生活技能分量表评分有更明显改善趋势。干预组用药亚组(11例)与未用药亚组(10例)SNAP-Ⅳ3个分量表评分均降低≥2分,但2个亚组评分降低差异无统计学意义;2组未用药亚组WFIRS-P评分均有下降,干预组未用药亚组较对照组未用药亚组“学习/学校”分量表评分改善明显,差异有统计学意义。干预组除转换因子外,干预后较前执行功能均有提升,差异有统计学意义。结论医校家结合方案有助于ADHD患儿核心症状和执行功能的改善。Background The treatment of attention deficit hyperactivity disorder(ADHD)emphasizes multi-model treatment.For now there is no long-term comprehensive intervention method with the medical-family-school cooperation model in China.Objective To evaluate the improvement effects of the medical-school-family cooperation model on core symptoms and learning and life function at home and school of ADHD patients.Design Non-randomized controlled study.Methods Children with ADHD attending medical-family-school cooperation project(age range 6-10)were selected as the intervention group.The control group matched by the ratio of 1:2 consisted of ADHD outpatients from the Department of Psychology in Children's Hospital of Fudan University.During the 4-month duration of the program,all patients were allowed to receive treatment as usual at their own clinics.Main outcome measures Changes in the scores of Chinese version of SNAP-Ⅳscale-parent(inattention,hyperactivity/impulsivity and oppositional score).Results Children with ADHD(n=27)in the medical-school-family treatment group did not differ from those in the control group(n=54)in age,pre-intervention drug using rate,parental age,education level of mother,family income,SNAP and WFIRS-P scores before treatment,but diffrences were significant in intelligence quotient.The scores of three subdomain of SNAP-Ⅳscale decreased by 2 points at least from baseline to the end of treatment in medical-family-school cooperative model intervention group.After the intervention in control group,SNAP-Ⅳinattention and hyperactivity/impulsivity scores declined by two points at least.Statistically significant differences were obtained in oppositional and total scores.There was no significant difference in the Weiss scores between the two groups before and after treatment,and the difference is close to significance in life skill scores.The scores of three subdomains of SNAP-Ⅳscale declined by two points at least both in medical-school-family treatment subgroups of no-medication(n=10)and medicati

关 键 词：注意力缺陷多动障碍 医家校结合模式 干预 

分 类 号：R749.94[医药卫生—神经病学与精神病学]