伴和不伴对立违抗障碍的注意缺陷多动障碍儿童智力和反应抑制功能分析
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摘要
目的探讨伴和不伴对立违抗障碍(ODD)的注意缺陷多动障碍(ADHD)儿童智力和反应抑制功能特点,为证明ODD是否会加重ADHD认知损害提供参考依据。方法 2015年1月-2017年11月选取符合美国精神障碍诊断与统计手册第五版(DSM-5)诊断标准的ADHD共患ODD(ADHD+ODD)、单纯ADHD(ADHD)、以及年龄、性别相匹配的正常健康儿童各30例,采用韦氏儿童智力测试第四版(WSIC-Ⅳ)对其进行智力测试,Stroop效应测试对其反应抑制功能进行评估并进行对比。结果两病例组在智力测试方面,言语理解、工作记忆、加工速度、认知效率指数、总智商方面均落后于对照组(F=3.663、5.761、5.436、9.468、6.412,P均<0.05);ADHD+ODD组的一般能力指数落后于正常对照组(F=2.751,P<0.05);两病例组在反应抑制功能测试中的字义干扰时间均多于对照组,差异具有统计学意义(F=7.910,P<0.05);两病例组之间智力及反应抑制功能比较,差异均无统计学意义(F=2.703、0.578,P均>0.05)。结论 ADHD儿童智力及反应抑制功能均落后于正常儿童,共病ODD会加重ADHD的儿童一般能力损害,但不会加重反应抑制功能损害。
Objective To investigate the characteristic of intelligence and response inhibition function in children with attention deficit hyperactivity disorder(ADHD)or comorbid ADHD and oppositional defiant disorder(ODD),in order to provide reference for ODD aggravating cognitive function of ADHD. Methods Children diagnosed with comorbid ADHD and ODD(ADHD+ODD),simple ADHD(ADHD)and normal controls participated in this study from January 2015 to November 2017,with 30 children in each group.All three groups were matched by age and gender.The diagnosis were made according to Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition(DSM-5)criteria.The Wechsler Intelligence Scale for Children-fourth edition(WISC-Ⅳ)and Stroop text were administered to assess the intelligence and response inhibition functions. Results The scores of VCI,WMI,PSI,CPI,full scale intelligence quotient(FSIQ)and word interference in two case groups were much lower than those in normal controls(F=3.663,5.761,5.436,9.468,6.412,all P<0.05);The general ability index in ADHD+ODD group was lower than that of normal controls(F=2.751,P<0.05),the scores of time for word interference in two case groups were much longer than those in normal controls(F=7.910,P<0.05).However,there were no significant difference on both intelligence and response inhibition function between the two case groups(F=2.703,0.578,both P>0.05). Conclusions Children with ADHD have intelligence and response inhibition function deficit no matter comorbidity or non-comorbidity of oppositional defiant disorder.Comorbid ADHD and ODD have additional influence on the general ability,but not on response inhibition function characteristics of children with ADHD.
Objective To investigate the characteristic of intelligence and response inhibition function in children with attention deficit hyperactivity disorder(ADHD)or comorbid ADHD and oppositional defiant disorder(ODD),in order to provide reference for ODD aggravating cognitive function of ADHD. Methods Children diagnosed with comorbid ADHD and ODD(ADHD+ODD),simple ADHD(ADHD)and normal controls participated in this study from January 2015 to November 2017,with 30 children in each group.All three groups were matched by age and gender.The diagnosis were made according to Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition(DSM-5)criteria.The Wechsler Intelligence Scale for Children-fourth edition(WISC-Ⅳ)and Stroop text were administered to assess the intelligence and response inhibition functions. Results The scores of VCI,WMI,PSI,CPI,full scale intelligence quotient(FSIQ)and word interference in two case groups were much lower than those in normal controls(F=3.663,5.761,5.436,9.468,6.412,all P<0.05);The general ability index in ADHD+ODD group was lower than that of normal controls(F=2.751,P<0.05),the scores of time for word interference in two case groups were much longer than those in normal controls(F=7.910,P<0.05).However,there were no significant difference on both intelligence and response inhibition function between the two case groups(F=2.703,0.578,both P>0.05). Conclusions Children with ADHD have intelligence and response inhibition function deficit no matter comorbidity or non-comorbidity of oppositional defiant disorder.Comorbid ADHD and ODD have additional influence on the general ability,but not on response inhibition function characteristics of children with ADHD.
引文
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[10]江文庆,李焱,杜亚松,等.注意缺陷多动障碍韦氏智力测验第四版测量结果分析[J].中国临床心理学杂志,2013,21(4):579-582.
[11]林文璇,王馨,吴婕翎,等.韦氏儿童智力量表第四版在注意缺陷多动障碍儿童智力结构分析中的应用[J].中国儿童保健杂志,2012,20(1):58-61.
[12]李宗磊,王文强,杨丽容,等.注意缺陷多动障碍儿童的智力及认知功能特征[J].神经疾病与精神卫生,2015,15(6):598-601.
[13]Xu MF,Jiang WQ,Du YS,et al.Executive function features in drug-naive children with oppositional defiant disorder[J].Shanghai Archives of Psychiatry,2017,29(4):228-235.
[14]Tanya N,Stephen P,Leanne T,et al.Hot and cool executive functions in children with attention deficit/hyperactivity disorder and comorbid oppositional defiant disorder[J].J Int Neuropsychol Soc,2015,21(8):584-595.
[15]Lourdes E,Roser G.Executive functions in preschoolers with ADHD,ODD,and comorbid ADHD-ODD:evidence from ecological and performance-based measures[J].J Neuropsy,2015,9(2):258-270.
[16]BarkIey RA.Behavioral inhibition,sustained attention,and executive functions:constructing a unifying theory of ADHD[J].Psychol Bull,1997,121(1):65-94.
[2]Barkley RA.Attention deficit hyperactivity disorder:a handbook for diagnosis and treatment[M].New York:Guilford Press,1998.
[3]刘津,王玉凤.儿童注意缺陷多动障碍共患对立违抗性障碍的危险因素研究[J].北京大学学报:医学版,2007,39(3):257-260.
[4]帅澜,王玉凤.共患破坏性行为障碍的注意缺陷多动障碍男孩的执行功能特点[J].北京大学学报:医学版,2007,39(3):241-246.
[5]耿耀国,苏林雁,苏巧荣,等.单纯多动症与伴对立违抗患儿智力和行为比较研究[J].中国学校卫生,2005,26(8):639-641.
[6]张厚粲.韦氏儿童智力量表第四版(WISC-Ⅳ)中文版的修订[J].心理科学,2009,32(5):1177-1179.
[7]Homack S,Riccio CA.A meta-analysis of the sensitivity and specificity of the Stroop Color and Word Test with children[J].Arch Clin Neuropsychol,2004,19(6):725-743.
[8]Leung P,Chan F.Neurocognitive deficits unclerlying attention deficit/hyperactivity disorder(ADHD):A clustering subgrouping analysis[J].European Psychiatry,2016,33(3):131.
[9]Jiang WQ,Li Y,Du YS,et al.Emotional regulation and executive function deficits in unmedicated Chinese children with oppositional defiant disorder[J].Psychiatry Investigation,2016,13(3):277-287.
[10]江文庆,李焱,杜亚松,等.注意缺陷多动障碍韦氏智力测验第四版测量结果分析[J].中国临床心理学杂志,2013,21(4):579-582.
[11]林文璇,王馨,吴婕翎,等.韦氏儿童智力量表第四版在注意缺陷多动障碍儿童智力结构分析中的应用[J].中国儿童保健杂志,2012,20(1):58-61.
[12]李宗磊,王文强,杨丽容,等.注意缺陷多动障碍儿童的智力及认知功能特征[J].神经疾病与精神卫生,2015,15(6):598-601.
[13]Xu MF,Jiang WQ,Du YS,et al.Executive function features in drug-naive children with oppositional defiant disorder[J].Shanghai Archives of Psychiatry,2017,29(4):228-235.
[14]Tanya N,Stephen P,Leanne T,et al.Hot and cool executive functions in children with attention deficit/hyperactivity disorder and comorbid oppositional defiant disorder[J].J Int Neuropsychol Soc,2015,21(8):584-595.
[15]Lourdes E,Roser G.Executive functions in preschoolers with ADHD,ODD,and comorbid ADHD-ODD:evidence from ecological and performance-based measures[J].J Neuropsy,2015,9(2):258-270.
[16]BarkIey RA.Behavioral inhibition,sustained attention,and executive functions:constructing a unifying theory of ADHD[J].Psychol Bull,1997,121(1):65-94.