注意缺陷与多动障碍儿童的家庭动力学研究(英文)

背景 对注意缺陷与多动障碍儿童需要辅于家庭治疗,开展这一辅助治疗就要求详细了解这些家庭的动力学特征。目的 探讨注意缺陷与多动障碍(Attention Deficit Hyperactivity Disorder,ADHD)儿童的家庭动力学特征。方法采用 19 项的系统家庭动力学自评量表(Questionnaire of Systematic Family Dynamics,QSFD)对就诊于南京脑科医院的 46 例ADHD患儿(10～17岁)和 46 名性别、年龄相同的对照学生的家庭动力进行评估。该量表评估家庭功能的4个维度:家庭气氛、个性化、系统逻辑以及疾病观念。结果 两组的疾病观念无明显差异。ADHD组患儿报告家庭氛围不佳,个性化程度低,家庭内更多使用"非此即彼"的绝对化逻辑。父母的受教育程度和家庭经济状况可能影响结果,校正了上述混杂因素的影响后,家庭氛围不佳和个性化程度低在ADHD患儿中仍有统计学意义。患儿自评的QSFD问卷4个维度的内部一致性欠佳(α=0.44～0.53)。结论 该研究初步调查了ADHD患儿的家庭动力学特征,结果显示,患儿报告的家庭气氛更显沉闷,家庭成员间情感和行为的分化程度低。今后需要进一步开展工作,以提高中国家庭动力学评估方法的效度,尤其是将孩子作为信息来源。尽管如此,在传统的药物治疗和行为治疗基础上对ADHD患儿辅以家庭治疗时,本研究的评估方法还是提供了有用的信息。

Family dynamics in families with children with Attention Deficit Hyperactivity Disorder

Background：Development of adjunctive family therapy for the treatment of children with Attention Deficit Hyperactivity Disorder（ADHD） in China requires a detailed understanding of the family dynamics of these families.Aim：Assess the family dynamics of families with children who have ADHD in Nanjing,China.Methods：Forty-six children 10 to 17 years of age treated at the Nanjing Brain Hospital for ADHD and 46 control children of the same age and gender from schools in Nanjing completed the 19-item Questionnaire of Systematic Family Dynamics（QSFD） which assesses four dimensions of family functioning：Family Atmosphere,Individuation,Moral Absolutism,and Personal Responsibility for Psychological Problems.Results：TherewerenodifferencesbetweengroupsintheperceivedcausesofpsychologicalproblemsbuttheADHDchildren reported a poorer family atmosphere,less independence from parents,and more ambiguity about‘right’ and‘wrong’in the family.After adjustment for the potential confounding effects of parental education and family economic status,the findings of poorer family atmosphere and less individuation in the ADHD children remained statistically significant.The internal consistency of the four dimensions of the QSFD as completed by the children were poor（alpha=0.44-0.53）.Conclusion：This preliminary study on the family dynamics of families with children that have ADHD finds that the ADHD children report a poor family atmosphere and little independence from parents.Further work is needed to validate the methods for assessing family dynamics in Chinese families,particularly when using children as informants,but this method provides valuable information that could be used as the focus of adjunctive family therapy to augment the traditional pharmacological and behavioral approaches to the treatment of ADHD.