麦普替林治疗注意缺陷多动障碍的疗效研究

目的　探讨麦普替林治疗注意缺陷多动障碍 (ADHD)的疗效及安全性。方法　符合CCMD 3诊断标准的ADHD患儿 32例 ,单一用麦普替林 2 5～ 12 5mg/d治疗 ,6周后进行临床疗效评定 ,治疗前后采用Conners儿童行为问卷 4 8项家长用症状问卷 (PSQ)评估对照。结果　有效 2 2例 ,有效率 6 8 75 % ,PSQ评估 6项因子分明显下降 ,其中因子Ⅲ (心身问题 )P <0 0 5 ,其余 5项因子分P <0 0 0 1。服药第 1周出现轻度口干、镇静、视物模糊、心跳增快 ,2周后逐步消失。结论　麦普替林治疗ADHD疗效肯定 ,副反应相对较轻 ,可作为治疗ADHD的首选药物之一。     

盐酸托莫西汀对注意缺陷多动障碍儿童行为特征的影响

目的:探讨托莫西汀能否改善注意缺陷多动障碍(ADHD)患儿的行为问题.方法:评价65例ADHD患儿(男56例,女9例)在托莫西汀治疗前及治疗4周、8周的行为问题.使用Conners父母症状问卷(PSQ)及长处与困难问卷(SDQ)进行评定.结果:与治疗前相比,PSQ中冲动多动因子及多动指数在治疗第4周及第8周后均有明显改...     

注意缺陷/多动障碍诊断标准的研究☆

目的使用DSM-Ⅳ中注意缺陷/多动障碍(AD/HD)诊断标准对一组多动综合征和一组无多动的儿童进行诊断,探讨DSM-Ⅳ的分布特征及在我国的适用性.方法多动组为就诊的多动症儿童,符合临床诊断和ICD-10诊断标准,共92例.对照组无多动的学校儿童96名.由家长填DSM-Ⅳ诊断表.结果在188名儿童中,符合DSM-ⅣAD/HD诊断99例,多动组87例(94.57%),对照组12例(12.5%),后者包括单纯注意障碍、学习障碍、情绪障碍及无问题的儿童.如以临床诊断/ICD-10为金标准,DSM-Ⅳ的诊断灵敏度为94.57%,特异度87.50%,诊断一致性为0.91.结论中国多动症儿童的多动/冲动症状难以达到DSM-Ⅳ的标准;DSM-Ⅳ标准扩大了诊断范围,主要是注意障碍为主型.在使用DSM-Ⅳ诊断时应考虑民族、文化、年龄、性别因素.     

RussellBarkIey父母培训八步法对注意缺陷多动障碍儿童干预的疗效

目的研究Russell Bark Iey父母培训八步法对注意缺陷多动障碍(ADHD)儿童干预的可行性和疗效,为临床干预提供依据。方法采用80名符合ADHD诊断标准的患儿为研究对象,随机分为研究组和对照组。均采用常规药物治疗、心理护理、健康教育,研究组另行为期10周、每周1次八步法家长培训。家长培训具体方法为:分析孩子对抗行为的原因,给予关注和表扬,物质奖励或者惩罚,在公共场所监管孩子、纠正孩子在学校的不良行为。实施前后采用自编调查问卷和Conners父母症状问卷进行效果评估。结果研究组和对照组有效率分别为76.92%和54.05%,经比较有统计学意义(X2=4.41,P0.05)。治疗10周后,研究组在品行问题、学习问题、心身问题、冲动-多动、焦虑、多动指数上均较治疗前有明显下降(t=7.2825、7.5142、6.9048、2.1560、7.1232、11.4252,P0.05),对照组在冲动-多动、焦虑、多动指数上均较治疗前有明显下降(t=2.5992、6.8614、2.8384,P0.05);组间比较:治疗10周后,研究组在品行问题、学习问题、心身问题与对照组有统计学意义(t=15.5986、3.9941、3.8795,P0.05)。有94.3%的家长觉得这个培训对管教孩子有帮助,并将此培训介绍给其他家长。结论家长培训可以有效改善ADHD儿童的核心症状,家长对培训的满意度高,可以在今后的临床护理工作中积极开展。     

儿童注意缺陷多动障碍的几种诊断方法探讨

目的　探讨儿童注意缺陷多动障碍 (ADHD)的诊断方法。方法　对家长或教师认为“多动”的 6～ 1 1岁儿童 1 98例 ,采用美国《精神障碍诊断和统计手册》第 4版 (DSM Ⅳ )的标准、持续性注意测验 (CAT)、Conners父母症状问卷 (PSQ)和简明症状问卷 (ASQ)分别作诊断。结果　 4种方法诊断为ADHD的分别有 1 1 0例、1 0 5例、1 0 5例和 95例 ,相应占 55 6 %、53 0 %、53 0 %和 4 8 0 %。后三者分别与前者比较均无显著差异 ( χ2 值分别为 0 2 5、0 .2 5和 2 2 8,P均大于 0 0 5)。CAT、PSQ和ASQ与DSM Ⅳ诊断比较 ,分别有 96 2 %、95 3%和 95 8%为符合与基本符合。CAT的敏感性、特异性和准确性分别为 91 8%、95 5%和 93 4 % ,PSQ的三项相应为 90 9%、94 3%和 92 4 % ,ASQ的三项相应为 77 3%、88 6 %和 82 3%。结论　CAT和PSQ的敏感性、特异性和准确性分别相近或高于目前最常用的ASQ(CAT三项的 χ2 分别为 8 91、2 79和 1 1 4 7,PSQ三项的 χ2 分别为 7 6 4、1 82和 9 1 6 ,P均分别为小于 0 0 5、大于 0 0 5和小于 0 0 5)。对DSM Ⅳ诊断标准具有较客观的补充作用 ,值得试用以至推广应用     

惠州市小学生注意力缺陷多动障碍流行病学调查与矫治干预模式研究

目的调查惠州市小学生注意力缺陷多动障碍(ADHD)的发病特点和流行病学特征,并探究矫治干预模式对患儿的治疗效果。方法对惠州市5所小学6～12岁的小学生进行整体的抽样调查,7 259例学生为本次调查对象。通过SNAP-Ⅳ家长评定量表对上述儿童家长进行问卷调查,对调查结果经专科医师采取DSM-Ⅳ诊断标准进行确诊。将确诊为ADHD的患儿随机分为2组,观察组采取矫治干预模式治疗,对照组患儿采取一般治疗措施。结果男性ADHD发病率10.55%,明显高于女性的3.61%,ADHD在8～10岁儿童中的发病率最高(7.01%);ADHD女性患儿中学习问题的检出率83.08%,明显高于男性;观察组和对照组的总有效率分别为82.98%、56.60%,差异有统计学意义(P<0.05)。结论 ADHD的发病率男孩高于女孩,且在8～10岁儿童中的发病率最高,矫治干预能有效提高ADHD的临床疗效。     

抽动秽语综合征共患注意缺陷多动障碍的 临床特征分析

目的 调查影响抽动秽语综合征（TS）共患注意缺陷多动障碍（ADHD）患者的临床特征。 方法 本研究包括回顾性研究和横断面调查研究两部分，回顾2005—2007 年在北京安定医院就诊并登 记入库的TS 患者的人口学资料和病例特征，并对TS 患者及家长进行横断面调查研究；由临床医生对患 者进行简明儿童少年神经精神访谈问卷（MINI-Kid）、DSM-5 诊断评估以及斯诺佩评估量表（SNAP- Ⅳ）评 估，由家长完成Conners父母症状问卷评估，由患者本人完成Conners自评量表和儿童自我意识量表评 估，并由临床医生对患者采用耶鲁布朗大体抽动严重程度量表（YGTSS）进行抽动症状严重程度评估并 记录其是否规律治疗TS，以及是否服用治疗ADHD药物。结果 221例患者纳入分析，其中138例（62.4%） 为TS 共患ADHD 患者，TS 共患ADHD组患者在围产期不良事件、发病年龄、首次诊断年龄、首次治疗年 龄、是否规律治疗及精神疾病家族史方面与TS 未共患ADHD 组差异有统计学意义，其症状严重程度与 围产期不良事件、是否规律治疗、是否接受ADHD 药物治疗及精神疾病家族史有关。明显症状组患者 接受ADHD 治疗比例低于轻微症状组。结论 TS 共患ADHD 治疗效果与围产期不良事件、是否规律治 疗、是否接受ADHD治疗以及精神疾病家族史有关。     

注意缺陷多动障碍核心症状对ADHD倾向儿童行为问题的影响

目的 探讨注意缺陷多动障碍（ADHD）核心症状对ADHD倾向儿童行为问题的影响,为早期识别ADHD患儿并进行有针对性的干预提供参考。方法 于2021年7月-8月,在广州市某小学筛选25名ADHD倾向儿童作为ADHD倾向组,纳入年龄、性别和年级相匹配的25名儿童作为正常组。采用中文版ADHD斯诺佩评估量表第4版（SNAP-IV）父母版评定ADHD核心症状,采用儿童困难问卷（QCD）和Conners父母症状问卷（PSQ）评定行为问题。采用Spearman相关分析考察ADHD核心症状与QCD和PSQ评分的相关性,采用分层线性回归分析探讨ADHD核心症状对行为问题的影响。结果 ①组间差异显示,ADHD倾向组的注意缺陷和多动-冲动因子评分均高于正常组（t=7.771、6.726,P均<0.01）。②相关分析显示,注意缺陷因子评分与QCD总评分呈负相关（r=-0.440,P<0.05）,与PSQ的学习问题因子评分呈正相关（r=0.457,P<0.05）;多动-冲动因子评分与PSQ的焦虑因子评分呈负相关（r=-0.457,P<0.05）,与PSQ的冲动-多动因子评分呈正相关（r=0.552,P<0.01）。③分层线性回归分析显示,注意缺陷因子评分可负向预测QCD总评分（B=-0.682,P<0.05,R²=0.468）;多动-冲动因子评分对PSQ的焦虑因子评分具有负向预测作用（B=-0.048,P<0.05,R²=0.367）,对PSQ的冲动-多动因子评分具有正向预测作用（B=0.077,P<0.01,R²=0.424）。结论 ADHD倾向儿童存在明显的注意缺陷症状、多动-冲动症状及行为问题,且注意缺陷症状可能是其日常行为问题的主要原因,多动-冲动症状可能是其冲动-多动行为问题的主要原因。     

注意缺陷多动障碍儿童家长心理健康状况及相关因素研究

目的 探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童家长心理健康状况及其相关因素.方法 采用症状自评量表(SCL-90)、自尊量表(SES)、社会支持评定量表、简易应对方式问卷对106名ADHD儿童家长进行评估.结果 ADHD儿童父母的SCL-90量表总均分及各分量表得分与正常儿童父母相比,差异具有显著性(P<0.01),ADHD儿童父母的SCL-90总均分与社会支持、应对方式中的积极应对、自尊水平呈负相关(P<0.01),与消极应对呈正相关(P<0.01).结论 ADHD儿童家长心理健康状况下降,应给予足够的重视及关注,预防减少心理问题的发生.     

注意缺陷多动障碍患儿的临床分型初探

目的 初步探索注意缺陷多动障碍(ADHD)患儿的临床分型.方法 使用根据美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)编制的儿童临床诊断性会谈量表(CDIS),对1999年9月至2000年8月门诊194例ADHD患儿进行评定,并以DSM-Ⅳ标准将其分为注意缺陷为主型(ADHD-I)、多动-冲动为主型(ADHD-HI)及混合型(ADHD-C)三个表型.结果 (1)亚型分布ADHD-I占45.9%(89例),ADHD-HI占7.7%(15例),ADHD-C占46.4%(90例);ADHD-C∶ADHD-I为1∶1.(2)CDIS量表总分194例的注意缺陷症状为(7.2±1.4)分,多动-冲动症状为(5.4±2.2)分;经方差分析,三个表型间注意缺陷和多动-冲动症状因子总分比较,差异均有非常显著性(P＜0.01).(3)核心症状频率194例中出现注意缺陷症状的频率为(79.5±2.9)%,多动-冲动症状的频率为(59.8±3.5)%.随年龄的增大,ADHD-HI和ADHD-C减少,ADHD-I增多.结论 在该样本中存在DSM-Ⅳ定义的三个表型,其中ADHD-HI的比例较低,ADHD-I与ADHD-C的比例相近;年龄对表型分布有影响.     

Behavioral parent training for Taiwanese parents of children with attention-deficit/hyperactivity disorder

It has been observed that it is relatively difficult for children with attention-deficit/hyperactivity disorder (ADHD) to follow social rules and behave in a socially desirable manner. The ADHD children in Chinese culture, which emphasizes Confucian values, might encounter even greater adjustment difficulties. The purpose of the present study is to implement a behavioral parent training program in a Confucian environment and examine its effectiveness. Twenty-three ADHD preschoolers (age: 3-6 years) and their parents were selected to participate in the present study. Fourteen of these 23 parents completed a 10-session parent training program. Parent ratings of ADHD/oppositional defiant disorder (ODD) symptoms and problem behaviors at home were collected at the first, fourth, sixth, seventh, and tenth sessions. Three instruments were used to evaluate treatment outcome: the Disruptive Behavior Rating Scale-Parent Form, Child Attention Profile, and Home Situations Questionnaire. The results showed that both ADHD/ODD symptoms and home behaviors of these 14 children improved significantly after the parent training. There was also a significant decline in the severity of symptoms and problem behaviors at home with the progression of training. These findings support the effectiveness of this parent training program for parents of ADHD children in an environment of Confucianism. Limitations of the present study and future direction for research are discussed.     

阿立哌唑治疗Tourette综合征共患注意缺陷多动障碍研究

目的探索阿立哌唑治疗Tourette综合征共患注意缺陷多动障碍患儿的疗效及安全性。方法选择Tourette综合征共患注意缺陷多动障碍患儿44例,随机分为阿立哌唑组和氟哌啶醇组,分别给予阿立哌唑和氟哌啶醇治疗12周,治疗前后采用耶鲁综合抽动严重程度量表(Yale global tic severity scale,YGTSS)和Conners(父母)症状问卷提供的多动指数标准评估患儿抽动症状及多动指数改善情况,并记录治疗过程中发生的药物副反应。结果重复测量方差分析示,对于YGTSS评分,分组主效应无统计学意义(P0.05),时间主效应、分组与时间的交互效应有统计学意义(P0.05);对于多动指数,分组主效应、时间主效应、分组与时间的交互效应均有统计学意义(P0.05)。治疗12周时,两组YGTSS评分无统计学差异(P0.05),阿立哌唑组多动指数低于氟哌啶醇组(P0.01)。阿立哌唑组出现副反应者(3/22)比氟哌啶醇组(6/22)少(P0.05)。结论阿立哌唑治疗Tourette综合征共患注意缺陷多动障碍患儿的抽动症状与氟哌啶醇相当,且可一定程度减轻其多动、注意力缺陷等症状,副作用较氟哌啶醇少。     

Review: Which components of behavioral parent and teacher training work for children with ADHD? – a metaregression analysis on child behavioral outcomes

Background

This metaregression analysis examined which behavioral techniques that are commonly used in behavioral parent and teacher training programs for children with attention-deficit/hyperactivity disorder (ADHD) were related to program effectiveness on children's behavioral outcomes.

Methods

We included 32 randomized controlled trials (N = 2594 children) investigating behavioral parent training, teacher training, or a combination, in children with ADHD under 18 years. Outcomes were symptom counts of total ADHD, inattention, and hyperactivity-impulsivity and behavioral problems. The dosage of techniques was extracted from the intervention manuals. Metaregression was used to assess which techniques and intervention characteristics (setting, delivery method, duration, and home-school collaboration) were associated with intervention effectiveness.

Results

Higher dosage of psycho-education for parents was associated with smaller effects on behavioral problems and, only in case of parent training, also with smaller effects on ADHD symptoms. Higher dosage of teaching parents/teachers to use negative consequences was associated with larger effects on behavioral problems. Individual training compared with group training was associated with larger effects on ADHD and hyperactivity-impulsivity symptoms.

Conclusions

This study provides first insights into the specific techniques that are essential in behavioral parent and teacher training programs for children with ADHD. This knowledge can eventually be used to improve and tailor interventions.     

Children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment: impact on parental practices

OBJECTIVE: To test the hypothesis that multimodal psychosocial intervention, which includes parent training, combined with methylphenidate significantly enhances the behavior of parents of children with attention-deficit/hyperactivity disorder (ADHD), compared with methylphenidate alone and compared with methylphenidate and nonspecific psychosocial treatment (attention control). METHOD: One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to short-term methylphenidate therapy were randomized for 2 years to receive either (1) methylphenidate treatment alone; (2) methylphenidate plus psychosocial treatment that included parent training and counseling, social skills training, academic assistance, and psychotherapy; or (3) methylphenidate plus attention control treatment. Parents rated their knowledge of parenting principles and negative and positive parenting behavior. Children rated their parents' behavior. RESULTS: Psychosocial treatment led to significantly better knowledge of parenting principles but did not enhance parenting practices, as rated by parents and children. Significant improvement in mothers' negative parenting occurred across all treatments and was maintained. CONCLUSIONS: In nonconduct-disordered, stimulant-treated children with ADHD, parent training does not improve self-rated parental behavior. The benefits of brief stimulant treatment for negative parental behavior are sustained with extended treatment.     

A small-scale randomized controlled trial of the self-help version of the New Forest Parent Training Programme for children with ADHD symptoms

The efficacy of a self-help parent training programme for children with attention deficit hyperactivity disorder (ADHD) was evaluated. The New Forest Parenting Programme Self-help (NFPP-SH) is a 6-week written self-help psychological intervention designed to treat childhood ADHD. Forty-three children were randomised to either NFPP-SH intervention or a waiting list control group. Outcomes were child ADHD symptoms measured using questionnaires and direct observation, self-reported parental mental health, parenting competence, and the quality of parent–child interaction. Measures of child symptoms and parental outcomes were assessed before and after the intervention. ADHD symptoms were reduced, and parental competence was increased by self-help intervention. Forty-five percent of intervention children showed clinically significant reductions in ADHD symptoms. Self-help intervention did not lead to improvements in parental mental health or parent–child interaction. Findings provide support for the efficacy of self-help intervention for a clinical sample of children with ADHD symptoms. Self-help may provide a potentially cost-effective method of increasing access to evidence-based interventions for clinical populations.     

The pragmatic language,communication skills,parent–child relationships,and symptoms of children with ADHD and their playmates 18-months after a parent-delivered play-based intervention

Objective: This study examined the communication skills, pragmatic language, parent–child relationships, and attention deficit hyperactivity disorder (ADHD) symptoms of children with ADHD and their playmates 18-months after a pilot parent-delivered intervention for improving social play skills and pragmatic language. Methods: Participants were five children with ADHD, their parents, and five typically-developing playmates. Outcomes were measured immediately post and 18-months following the intervention. Parent-rated norm-based assessments and an observational measure were used. Differences within and between the ADHD and playmate groups were examined. Results: Children maintained all skills gained 18-months following the intervention. Compared to a normative sample, children with ADHD remained below the average range on aspects of communication skills, parent–child relationships, and ADHD symptom levels 18-months following intervention. Conclusions: After intervention, children with ADHD still experienced pragmatic language skills below those of their peers on norm-based assessments that measure their skills across contexts. School-based interventions are needed to facilitate ongoing skill development and generalization.     

ADHD in Swedish 3- to 7-year-old children

OBJECTIVE: To study characteristics of attention-deficit/hyperactivity disorder (ADHD) in a representative group of clinically impaired young children in Sweden with the disorder. METHOD: One hundred thirty-one children with ADHD (aged 3-7 years) were examined, and their parents were interviewed. Independent parent questionnaire data (Child Behavior Checklist, ADHD Rating Scale-IV, Conners) were collected. For comparison 131 children without ADHD were matched for age, gender, parents' marital status, child's adoption status, and social class. RESULTS: Children with ADHD had extremely high ADHD symptom levels--on average four to eight times higher than the comparison group. Sociodemographic correlates of ADHD symptoms were more pronounced in parent questionnaire data than in parent interview data, underscoring the importance of diagnostic interview when dealing with clinical issues. Very few of the children with ADHD (6%) appeared "normal" with regard to attention/activity level at clinical examination. CONCLUSIONS: Clinic children with a diagnosis of DSM-IV ADHD have typical and impairing symptoms already before starting school. The variance of ADHD in this age group appears to be accounted for by primary psychosocial factors only to a limited degree. It would seem reasonable to establish supportive and treatment measures for these young children so that the psychosocial and academic problems shown by so many individuals with ADHD later in their development might be reduced.     

A meta-analysis of behavioral parent training for children with attention deficit hyperactivity disorder

This meta-analysis examined the effect of behavioral parent training on child and parental outcomes for children with attention deficit hyperactivity disorder. Meta-analytic procedures were used to estimate the effect of behavioral parent training on children with attention deficit hyperactivity disorder. Variables moderating the intervention effect were examined. Forty studies were included and generated an overall moderate effect size at post-treatment and a small effect size at follow-up. The majority of outcome categories were associated with a moderate effect size at post-treatment that decreased to a small effect size at follow-up. Parenting competence was the only outcome that had a large effect, which decreased to moderate at follow-up. The strength of the effect differed between questionnaire and observation measures. Behavioral parent training is an effective intervention for children with attention deficit hyperactivity disorder. Sustainability of the effects over time is a problem that awaits further scrutiny. Recommendations for further research and clinical practices are provided.     

Parent-based therapies for preschool attention-deficit/hyperactivity disorder: a randomized, controlled trial with a community sample

OBJECTIVE: To evaluate two different parent-based therapies for preschool attention-deficit/hyperactivity disorder (ADHD) in a community sample. METHOD: Three-year-old children displaying a preschool equivalent of ADHD (n = 78) were randomly assigned to either a parent training (PT; n = 30), a parent counseling and support (PCO&S; n = 28), or a waiting-list control group (n = 20). The PT group received coaching in child management techniques. The PC&S group received nondirective support and counseling. Measures of child symptoms and mothers' well-being were taken before and after intervention and at 15 weeks follow-up. RESULTS: ADHD symptoms were reduced (F2,74 = 11.64; p < .0001) and mothers' sense of well-being was increased by PT relative to both other groups (F2,74 = 10.32; p < .005). Fifty-three percent of children in the PT group displayed clinically significant improvement (chi 2 = 4.08; p = .048). CONCLUSIONS: PT is a valuable treatment for preschool ADHD. PC&S had little effect on children's behavior. Constructive training in parenting strategies is an important element in the success of parent-based interventions. Psychostimulants are not a necessary component of effective treatment for many children with preschool ADHD.