哌甲酯控释剂对注意缺陷多动障碍儿童执行功能的影响

目的:探讨哌甲酯控释剂能否改善注意缺陷多动障碍(ADHD)儿童的执行功能及改善的程度.方法:采用Stroop色词命名任务、Rey复杂图形测试、数字广度、连线测试、汉诺塔和言语流畅性任务,对符合美国《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)诊断标准的29例ADHD患儿应用哌甲酯控释剂治疗前后的执行功能的各个层面进行评估,并与24例正常男孩(年龄相匹配)的执行功能相比较.结果:治疗后,ADHD患儿的Stroop 1试错误数、2和4试的耗时及错误数,Rey复杂图形记忆任务即时记忆和延迟回忆的结构及细节得分,数字字母连线时间和转换用时,汉诺塔的耗时、操作次数、犯规次数的测验成绩均比治疗前有明显改善,且与正常对照组相比差异均无统计学意义.治疗后ADHD患儿汉诺塔的起始思考时间比治疗前明显缩短.结论:哌甲酯控释剂可以改善ADHD患儿的执行功能,包括抑制、视觉工作记忆、定势切换和计划能力;除抑制能力外,其余各项均可达正常水平.

Effect of methylphenidate on executive function for children with attention deficit hyperactivity disorder

OBJECTIVE: To explore whether methylphenidate (MPH) can improve the executive function (EF) of attention deficit hyperactivity disorder (ADHD) children and the degree of the improvements. METHOD: We conducted an open study of 29 children (25 boys and 4 girls) who met DSM-IV criteria for ADHD. The variations of their EF before and after methylphenidate extended-release tablets osmotic release oral system(OROS) methylphenidate] treatment were evaluated, and the differences of EF between 24 ADHD boys before and after treatment and 24 age-matched typically developing control boys were compared. The research instruments included Stroop color-word task, Rey complex figure test, digit span test, trail making test, tower of Hanoi and verbal fluency test. RESULTS: The performances of errors in Stroop 1, time and errors of Stroops 2 and 4; the immediate memory and delay recalling of structure and detail score of RCFT; time of number-letter trail making, shifting time; total time and steps, rule violation of tower of Hanoi improved significantly after OROS methylphenidate treatment as compared with those before treatment. They were no significant differences between ante- and post-treatment. The initiation planning time of tower of Hanoi was significantly shorter after treatment as compared with that before treatment . CONCLUSION: This study suggests that methylphenidate can improve the executive function in the aspects of inhibition, visual working memory, set shifting and planning in ADHD children, and almost all aspects of EF can reach the normal level except the inhibition.