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－Ⅳ ＡＤ／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。

The study of diagnostic criteria for attention deficit hyperactivity disorder

Objective To examine the practicing of DSM-IV in China by comparing DSM-IV diagnostic criteria for attention deficit/hyperactivity disorder(AD/HP) with ICD-10 hyperkinetic disorder criteria in the same children. Methods The sample involved two groups 92 children in AD/HD group, 96 elementary school students in control group. The children of AD/HP group were selected from clinic-referral to the Department of Child Psychiatry. They received ICD-10 hyperkinetic disorder diagnosis as well as clime observations. The students who meet ICD-10 criteria would be excluded from control group. All parents were asked to complete a rating scale based on DSM-IV symptoms for AD/HP. Results Ninety-nine out of 188 children met DSM-IV AD/HD diagnosis. including 87 cases in the AD/HP group, and 12 in the control group. The sensitivity was 94.57%, the specificity was 87.5%. and the agreement rate was 0.91 with ICD-10.Conclusions Some AD/HD children did not meet DSM-IV diagnosis because their rating scale score of hyperactivity-impulsivity(HI) was lower than the abnormative thresholds. Clinical manifestation of HI was less typical in Chinese children. DSM-IV criteria are likely to increase the chance of this diagnosis because it includes some ADD, learning difficulty, emotional disorder and others who meet PI subtype These findings suggest that age, sex, cultural and racial differences need to be considered in diagnosing children as AD/HP.