未经药物治疗的对立违抗障碍患儿的执行功能特征

背景:对立违抗障碍(ODD)以显著的对立、违抗和破坏性行为为主要特征,和品行障碍(CD)一样,被认为是破坏性行为障碍(DBD)的一种.然而,相比较与CD,ODD并不包括严重的攻击或者反社会行为.目的:本研究旨在探索ODD患儿的执行功能(EF)特征.方法:采用病例对照的研究设计.入组研究的ODD组有43例(pure ODD患儿14例和ODD/ADHD患儿29例),和pure ADHD患儿39例.健康对照组参与研究的有52例.采用Stroop色词测试,韦克斯勒智力量表儿童版(第四版,WISC-Ⅳ),威斯康辛卡片分类测试(WCST),和剑桥成套神经心理测试(CANTAB)对ODD和单纯注意缺陷多动障碍(ADHD)儿童进行执行功能测试,并且在控制了年龄以后,与健康发育儿童作比较.采用Logistic回归分析,探索执行功能缺陷在ODD(包括单纯ODD和ODD/ADHD)和单纯ADHD发生中的风险.结果:控制年龄因素后,ANCOVA方差分析结果显示相比较于对照组,ODD组在Stroop色-词测试,WISC-Ⅳ的倒背数字广度、WCST的持续反应数和概念化水平的得分更低,而在CANTAB任务视觉空间记忆(SWM)的错误数和策略分的得分更高.Logistic回归分析发现Stroop色词测试乙表读数进入ODD的回归方程.总结:ODD的患儿在执行功能任务时表现得更差.反应抑制缺陷是ODD的风险因素,而反应抑制和工作记忆缺陷是ADHD的风险因素.

Executive Function Features in Drug-naive Children with Oppositional Defiant Disorder

Background:Oppositional defiant disorder (ODD) that is characterized by markedly defiant,disobedient,and disruptive behavior in younger children has been regarded as disruptive behavior disorder (DBD),together with conduct disorder (CD).However,in contrast to CD,ODD does not include severe aggressive or antisocial behavior.Aim:This study aimed to examine executive function (EF) features of children with oppositional defiant disorder (ODD).Methods:Cross sectional design was used in this study.The EF of children with ODD and pure attention deficit hyperactivity disorder (ADHD) were compared with children without a psychiatric disorder,using the Stroop Color-Word Tests A and B,Wechsler Intelligence Scale for Children (Fourth Edition;WlSCⅣ),Wisconsin Card Sorting Test (WCST),and Cambridge Neuropsychological Test Automated Battery (CANTAB) corrected for age.Logistic regression analysis was conducted to identify risk factors for EF deficits characteristic of ODD and ADHD.Results:The ODD group exhibited significantly lower scores in both Stroop Color-Word Tests,the backwards digital span of the WISC-Ⅳ,and the categories completed and perseverative responses of the WCST,and significantly higher scores in spatial working memory (SWM) between errors,and the strategy in SWM of the CANTAB compared with the control group.When the ODD group was designated as 1 and the ADHD group was designated as 0,digital span (X1) fit the regression equation very well.Conclusions:Children with ODD perform substantially worse in EF tasks.Responsive inhibition appears to be uniquely associated with ODD development,while responsive inhibition and working memory appear to be associated with ADHD.