对立违抗性障碍、注意缺陷多动障碍儿童的冲动行为及社会心理因素

目的:探讨对立违抗性障碍(ODD)、注意缺陷多动障碍(ADHD)及二者共病儿童的冲动行为与心理社会因素的关系。方法:以152例正常儿童为对照组,以157例符合美国精神障碍诊断与统计手册第4版Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-IV)的ODD、ADHD、ODD合并ADHD,且Barratt冲动量表平均量表分≥正常组均值1.5个标准差的儿童为病例组,采用父母养育方式评价量表(EMBU)、家庭功能评定(FAD)、3～7岁儿童气质问卷(BSQ)、8～12岁儿童气质问卷(MCTQ)、儿童自我意识量表(PHCSS)、自尊调查量表(SEI)及Conners教师问卷(TRS)进行测查。结果:病例组EMBU父母情感温暖及理解得分低于对照组,惩罚及严厉、拒绝及否认得分高于对照组(均P0.05)。病例组FAD的情感介入、行为控制和总功能分值高于对照组(均P0.05)。病例组气质问卷的活动水平、节律性、反应强度、心境特征、持久性、注意分散维度分值高于对照组,病例组气质类型为麻烦型及中间近麻烦型的比例高于对照组(均P0.05)。病例组SEI总分低于对照组,Conners教师问卷的品行问题、多动、注意不集中-被动及多动指数高于对照组(均P0.05)。回归分析显示,夫妻关系差(OR=4.69)、父亲对儿童缺乏情感温暖及理解的养育方式(OR=1.06)、对新环境的适应能力差(OR=2.60)、对新刺激的反应阈值低(OR=2.75)及注意不集中(OR=3.60)可能是儿童发生冲动行为的危险因素;母亲的否认及拒绝少(OR=0.90)、运动冲动性弱(OR=0.83)、活动水平低(OR=0.19)、反应强度弱(OR=0.38)、多动指数低(OR=0.15)、问题解决好(OR=0.38)和情感介入少(OR=0.20)可能是儿童冲动行为的保护因素(P0.05)。结论:研究提示有冲动行为的ODD、ADHD儿童可能存在自尊程度较低、父母养育方式不良及家庭功能紊乱等社会心理因素。     

父母养育方式与学习不良儿童行为问题及自我意识的相关研究

目的 :探讨学习成绩不良儿童的行为问题、自我意识与父母养育方式的关系。方法 :采用Conners儿童行为问卷 (父母版 )、Piers -Harris儿童自我意识量表以及父母养育方式问卷对 34名成绩不良儿童和 4 7名成绩优良儿童进行评定。结果 :学习成绩不良儿童较成绩优良儿童行为问题较多 ,自我意识水平较低。相关分析显示 ,成绩不良儿童的行为问题与父母的温暖和理解呈负相关 ,与父母的偏爱呈正相关 ;父母的温暖和理解与成绩不良儿童的自我意识水平呈正相关 ,而父母的惩罚、拒绝否认、偏爱以及过度保护等与儿童自我意识的不同维度呈负相关。结论 :某些不适当的父母养育方式对学习成绩不良儿童的心理健康具有不利影响。     

ADHD儿童行为与教育子女方式问题的相关分析

目的:探讨注意缺陷多动障碍(ADHD)儿童的父母教育子女方式的特点及其与ADHD儿童行为问题的关系.方法:选用子女教育心理控制源量表(PLOC)、Conners父母症状问卷(PSQ)分别对30例ADHD及正常儿童进行评定.结果:ADHD儿童的父母在PLOC量表中教育成效、父母的责任、父母对命运/机遇的信念、父母对子女行为控制的评分高于对照组(P<0.05).PLOC的某些因素与ADHD儿童行为问题存在相关关系.结论:ADHD儿童有较多的行为问题,可能与父母教育方式有关.     

儿童自我意识量表的中国城市常模

目的 :建立Piers Harris儿童自我意识量表的中国城市常模并检验信度和效度。方法 :在全国 2 0个城市采样 16 98例 (男 846 ,女 85 2 ) ,平均 11 5 1± 2 5 9岁。由儿童填写儿童自我意识量表。结果 :量表的重测信度、分半信度、Crobachα系数为 0 6 95～ 0 85 8,项目与总分的一致性为 0 0 78～ 0 4 6 7,除 3项外均达显著性水平。量表与Conners父母问卷、教师评定量表的各分量表有显著相关。结论 :儿童自我意识量表适用于我国儿童自我意识的评估。     

青少年友谊嫉妒对攻击行为的影响：自尊与自我控制的链式中介作用

目的：探讨友谊嫉妒对攻击行为的影响及自尊与自我控制在其中的中介作用。方法：本研究采用友谊嫉妒问卷、自尊量表、自我控制量表及攻击问卷对664名青少年进行调查。结果：友谊嫉妒、自尊、自我控制与攻击行为两两之间存在显著相关;友谊嫉妒对攻击行为的直接效应显著,自尊、自我控制在友谊嫉妒与攻击行为之间的中介和链式中介作用均显著。结论：友谊嫉妒既可以直接引发攻击行为,又可以通过自尊、自我控制的单一中介效应和自尊→自我控制的链式中介效应间接引发攻击行为。     

对立违抗性障碍儿童的父母养育方式、子女教育心理控制源及家庭功能特点

目的:了解具有对立违抗性障碍(oppositional defiant disorder,ODD)儿童父母养育方式、子女教育心理控制源及家庭功能的特点。方法:对来自湖南省中小学生精神障碍流行病学调查研究中的全部对象进行DSM-IV诊断,其中符合ODD诊断标准的对象225人及对照组225人由父母填写子女教育心理控制源量表,儿童自己填写父母养育方式评价量表、家庭亲密度和适应性量表中文版。结果:ODD组在父、母亲惩罚、干涉、偏爱、拒绝及父亲过度保护等方面得分显著高于对照组(P<0.05);同时在教育成效、子女对父母生活的控制、父母对子女行为控制方面得分显著高于对照组(P<0.01)。而ODD组家庭实际亲密度、实际适应性和理想适应性得分显著低于对照组(P<0.05)。结论:ODD患者的父母存在不良的养育方式,心理控制源外控性较强,家庭亲密度低、适应性差。     

儿童自我意识与行为问题的关系探讨

目的 :探讨儿童自我意识与行为问题之间的关系。方法 :采用Piers-Harris儿童自我意识量表、Conners儿童行为问卷对 2 0 6 3例儿童进行问卷调查 ,然后探讨行为问题儿童的自我意识与行为问题的关系。结果 :检出行为问题 395例 ,其自我意识水平明显低于正常儿童 (P <0 .0 0 1)。自我意识与行为问题有明显负相关 ,其不同侧面对行为问题有不同影响。躯体外貌与属性、行为、幸福与满足、焦虑、智力与学校情况对行为问题有一定预测作用。结论 :加强积极的自我意识的培养有助于儿童行为问题的预防和干预。     

医学院校大学生自我同一性与父母教养方式、自尊关系的研究

目的 考察医学院校大学生自我同一性发展与父母教养方式、自尊的关系.方法 采用自我同一性状态客观测量的标准化量表(EOM-EIS-2)、自尊问卷(SES)和父母教养方式评价量表(EMBU)对齐齐哈尔医学院384名大学生进行调查.结果 ①父母不同教养方式对医学院校大学生自我同一性状态不同维度存有影响;②自尊与自我同一性的不...     

家庭环境与ADHD儿童某些心理特征相关性的研究

目的 :探讨注意缺陷多动障碍 (AttentionDeficit -Hyperactivedisorder,ADHD)儿童家庭环境特点及其与儿童自我意识、自尊、内外控等心理特征的关系。方法 :选用家庭环境量表 (FES)、Piers -Harris儿童自我意识量表、自尊调查 (TheSelf-esteemInventory ,Coopersmith)、儿童内外控量表 (Nowicki-StricklandInternal -ExternalControlScaleforChildren)以及艾森克个性问卷 (EPQ -儿童版 )分别对 10 8例ADHD及 10 8名正常儿童进行评定。结果 :ADHD儿童的家庭在FES量表中家庭亲密度、情感表达、文化性、独立性、知识性、娱乐性、道德观、家庭组织性上的得分都显著低于对照组 (均P <0 0 5 ) ;而在家庭的矛盾性高于对照组 (P <0 0 5 )。ADHD儿童的自我意识、自尊水平均明显低于正常对照组的儿童。ADHD儿童表现更为外控 ,而正常对照组则更为内控。ADHD儿童在精神质、神经质得分高于对照组 ,掩饰性低于对照组。FES量表中的家庭环境因素对ADHD儿童的自我意识、自尊、内外控及个性特征没有显著影响 ;而正常组儿童的这些心理特征与家庭环境中的某些因素有关。结论 :家庭环境因素对ADHD和对照组儿童自我意识、自尊、内外控及个性特征发展的影响是不同的     

中文版反社会性行为特质筛查问卷(APSD)父母版的效度和信度

目的:评价中文版反社会性行为特质筛查问卷(APSD)父母版的效度与信度。方法:选取符合精神障碍诊断与统计手册第5版(DSM-5)诊断标准的注意缺陷多动障碍(ADHD,n=161)、对立违抗障碍(ODD,n=117)和品行障碍(CD,n=13)的儿童291例,以及年龄性别相匹配的正常儿童288例为研究对象(年龄6~13岁)。请其家长填写APSD父母版以评估儿童冷漠无情特质,填写Vanderbilt父母评定量表(VADPRS)及Conners父母症状问卷(PSQ)以评估儿童的行为问题,随机选取48名家长间隔1~3周再次填写APSD父母版问卷。对数据进行验证性因素分析、同时效度、受试者工作特征(ROC)曲线和内部一致性信度及重测信度分析,以评估APSD的效度和信度。结果:验证性因素分析显示,APSD 3因子模型结构拟合良好。同时效度,APSD与Vanderbilt父母评定量表及Conners父母症状问卷因子呈正相关(r=0.31~0.79,P0.01)。ROC曲线显示,当APSD的T值为56时,诊断ADHD的灵敏度为0.82,特异度为0.81。APSD的内部一致性为0.65~0.83,重测信度为0.63~0.82。结论:中文版APSD父母版具有良好的效度和信度。     

Heritability and the comorbidity of attention deficit hyperactivity disorder with behavioral disorders and executive function deficits: a preliminary investigation

The heritability and comorbidity of attention deficit hyperactivity disorder (ADHD) with conduct disorder (CD), oppositional defiant disorder (ODD), and executive function (EF) deficits were examined in 224 child twins (140 monozygotic and 84 dizygotic). The Coolidge Personality and Neuropsychological Inventory for Children (Coolidge, 1998), a standardized, 200-item, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) aligned, parent-as-respondent inventory, assessed psychopathology. Structural equation model fitting revealed that the individual scale heritabilities were substantial: .82 for ADHD, .74 for CD, .61 for ODD, and .77 for EF deficits. The results of the multivariate twin analyses suggest that ADHD shares most of its genetic liability with CD, ODD, and EF deficits. Thus, the findings argue for a common biological risk underlying these commonly comorbid externalizing behavior problems and cognitive deficits. The residual genetic variance provides preliminary support for additional genetic influences underlying CD, ODD, and EF that are independent of ADHD.     

伴与不伴对立违抗性障碍的ADHD儿童行为特征分析

目的 :了解伴与不伴对立违抗性障碍 (ODD)的注意缺陷 /多动障碍 (ADHD)行为特征。方法 :对门诊就诊儿童以ICD - 10中ADHD和ODD诊断标准进行诊断 ,得到ADHD伴ODD者 78例 (占总数中 6 7.2 4 % ) ,ADHD不伴ODD者 38例 (占总数中 32 .76 % )。采用自行编制的家庭情况调查表 ,调查每一患儿情况。采用家长填Achenbach儿童行为量表 ,评定儿童行为。结果 :合并组家长对儿童不良行为处理方式 ,如经常打骂比ADHD组多 ;合并组社交、思维、注意、违纪问题 ,攻击行为 ,外化性问题 ,行为总分均高于ADHD组。结论 :ADHD合并ODD的发生率较高。ADHD合并ODD比单纯ADHD在社交、思维、注意、违纪、攻击行为方面有更广泛的损害 ,应引起重视。     

Treating oppositional defiant disorder in primary care: a comparison of three models

OBJECTIVE: To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder (ODD) in pediatric primary care. METHODS: Twenty-four practices were randomized to conditions in which parents of 117, 3- to 6.11-year-olds with ODD received the 12-session Webster-Stratton Incredible Years program led by primary care nurses or clinical psychologists, or to a minimal intervention group in which parents received only the companion book to the treatment program. RESULTS: There was improvement across posttreatment and 12-month follow-up for all groups, but no overall treatment group effects. There was a dose effect, with a reliable, clinically significant gain after seven sessions on the Eyberg intensity scale, and nine sessions on the Child Behavior Checklist externalizing scale. CONCLUSIONS: There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions.     

伴ADHD的对立违抗性障碍儿童行为特征分析

目的：了解伴注意缺陷／多动障碍(ADHD)的对立违抗性障碍(0DD)患儿的行为特征。方法：以ICD-10作为诊断标准对门诊就诊儿童进行诊断，得到ODD伴ADHD者40例(64.52％)．ODD不伴ADHD者22例(35．48％)。自编家庭情况调查表调查患儿的基本情况。用家长填Achenbach儿章行为量表评定儿童行为。结果：与ODD组相比。合并ADHD组的家长更多对患儿经常打骂和严厉管教：对儿童的不良行为更多地采取打骂的方式。合并组父亲急燥易怒者比ODD组多；合并组起病年龄及就诊年龄比ODD组早：合并组在CBCI。思维、注意问题，违纪、攻击行为，外化性问题，行为总分均高于ODD组。结论：ODD合并ADHD的患儿在思维、注意问题，违纪、攻击行为，外化性问题方面表现更突出，家长对儿童管教方式及不良行为处理方式影响ODD的发生。提示要注重ODD、ADHD的早期干预。     

The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study

BACKGROUND: A better understanding of the long-term scope and impact of the co-morbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in attention deficit hyperactivity disorder (ADHD) youth has important clinical and public health implications. METHOD: Subjects were assessed blindly at baseline (mean age=10.7 years), 1-year (mean age=11.9 years), 4-year (mean age=14.7 years) and 10-year follow-up (mean age=21.7 years). The subjects' lifetime diagnostic status of ADHD, ODD and CD by the 4-year follow-up were used to define four groups (Controls, ADHD, ADHD plus ODD, and ADHD plus ODD and CD). Diagnostic outcomes at the 10-year follow-up were considered positive if full criteria were met any time after the 4-year assessment (interval diagnosis). Outcomes were examined using a Kaplan-Meier survival function (persistence of ODD), logistic regression (for binary outcomes) and negative binomial regression (for count outcomes) controlling for age. RESULTS: ODD persisted in a substantial minority of subjects at the 10-year follow-up. Independent of co-morbid CD, ODD was associated with major depression in the interval between the 4-year and the 10-year follow-up. Although ODD significantly increased the risk for CD and antisocial personality disorder, CD conferred a much larger risk for these outcomes. Furthermore, only CD was associated with significantly increased risk for psychoactive substance use disorders, smoking, and bipolar disorder. CONCLUSIONS: These longitudinal findings support and extend previously reported findings from this sample at the 4-year follow-up indicating that ODD and CD follow a divergent course. They also support previous findings that ODD heralds a compromised outcome for ADHD youth grown up independently of the co-morbidity with CD.     

Dysthymic disorder contributes to oppositional defiant behaviour in children with Attention Deficit Hyperactivity Disorder, combined type (ADHD-CT)

BACKGROUND: The specific relationships between oppositional defiant disorder (ODD), ADHD-CT, dysthymic disorder (DD) and anxiety disorders symptoms have not been studied in children with ADHD-CT. The relationship to DD is important because DD is common, has an earlier age of onset, is associated with significant morbidity and with increased rates of treatment non-responsiveness when comorbid with major depressive disorder and/or ADHD-CT. METHODS: 200 clinically referred children with ADHD-CT, without comorbid major depressive disorder, were identified. "ODD", "ADHD-CT", "DD" and "anxiety disorders" symptoms were defined by composite measures of (1) semi-structured clinical interview and (2) parent and/or child standardized questionnaires. Standard multiple regression was used to examine how well "ADHD-CT", "DD" and "anxiety disorders" symptoms predict "ODD" symptoms. RESULTS: Only "ADHD-CT" (15% of the variance) and "DD" (8% of the variance) symptoms made independent significant contributions to the prediction of "ODD" symptoms. LIMITATIONS: The study's sample size did not allow "ODD" and "conduct disorder" symptoms to be analysed separately. CONCLUSIONS: The association of DD with ODD may reflect a unique contribution of DD to ODD in children, whether ADHD-CT is present or not, or only when ADHD-CT is present.     

Validation of population-based ADHD subtypes and identification of three clinically impaired subtypes.

Statistically based classification methods have successfully refined ADHD into homogenous and heritable subtypes. External validity and impairment of these subtypes was examined using the Child Behavior Checklist (CBCL). We compared mean CBCL syndrome and competency t-scores across ADHD subtypes defined by latent class analysis in a sample of 1,346 individual twins from Missouri. The potential for comorbidity with conduct disorder (CD), oppositional defiant disorder (ODD), or major depression (MD) to increase impairment in specific ADHD subtypes was also examined. CBCL profiles confirm differences in severity, with more severe classes having increased syndrome scale and decreased competency scale CBCL scores. Clinically significant impairment was found for severe inattentive and combined subtypes and the mild combined subtype. Overall, the presence of comorbid CD, ODD, or MD did not result in increased ADHD subtype impairment. CBCL scores distinguish impairment in ADHD subtypes created through LCA. Comorbidity with CD, ODD, or MD does not significantly increase impairment among ADHD subtypes. The mild combined ADHD subtype represents a clinically significant but under-studied form of ADHD.     

伴与不伴对立违抗性障碍的注意缺陷多动障碍儿童自我意识分析

目的:探讨注意缺陷多动障碍(ADHD)儿童伴对立违抗性障碍(ODD)的自我意识特点。方法:对湖南省六个地区进行抽样调查,共抽样9495名儿童。用二阶段流行病学调查方法后,凡符合诊断标准的儿童填写儿童自我意识量表(Children's self-concept Scale,CSCS),其中最后CSCS资料齐全者425人(对照组146人,单纯ADHD 170人,AD-HD伴ODD 109人)。结果:单纯ADHD组及ADHD合并ODD组在量表总分方面明显低于对照组(P<0.01),主要表现在行为因子、智力因子、焦虑因子、合群因子、幸福因子方面;在躯体因子这一项目上单纯ADHD组及ADHD合并ODD组得分也低于对照组(P<0.05)。ADHD合并ODD组在量表总分上要明显低于单纯ADHD组,表现在行为因子、智力因子、焦虑因子、合群因子、幸福因子方面;在躯体因子这一项目上ADHD合并ODD组得分要高于单纯ADHD组。结论:伴或不伴ODD的ADHD患儿的自我意识都明显比正常儿童差,而伴ODD的ADHD患儿自我意识又要明显比不伴ODD的ADHD患儿差。     

Oppositional Defiant Disorder and Conduct Disorder in Boys: Patterns of Behavioral Covariation

Studied patterns of covariation among symptoms of conduct problems in an outpatient clinic sample of 177 boys. These patterns were examined in relation to criteria for oppositional defiant disorder (ODD) and conduct disorder (CD), according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSMIll-R]; American Psychiatric Association, 1987). Factor analysis of parent and teacher responses to a structured psychiatric interview revealed two dimensions of conduct problems similar to the distinction between ODD and CD. However, some symptoms often associated with CD (bullying and violation of major rules) consistently loaded uniquely on the factor composed of ODD symptoms, and the DSMIII-R symptoms of fighting and lying had approximately equal loadings on both factors. Cluster analysis of scores derived from summing items with unique loadings on the ODD and CD factors yielded three profiles: deviance on only the ODD factor, deviance on both the ODD and CD factors, and deviance on neither factor. A distinct cluster of children with elevations only on the CD factor did not emerge.     

Co‐occurrence of ODD and Anxiety: Shared Risk Processes and Evidence for a Dual‐Pathway Model

[Clin Psychol Sci Prac 17: 307–318, 2010] Although oppositional defiant disorder (ODD) and anxiety disorders (ADs) often co‐occur, the literature is mixed regarding the effects of such co‐occurrence. For example, there is evidence that AD symptoms may mitigate ODD symptoms (buffer hypothesis) or exacerbate ODD symptoms (multiple problem hypothesis). A dual‐pathway model incorporates previous research and addresses both hypotheses. We describe several possible etiological or risk processes that may underlie each of these ODD–AD pathways, including child temperament, aggression, limbic system processes, executive functioning abilities, and social information–processing biases, and suggest an integrated model. We conclude with implications for the model and directions for future research involving co‐occurring ODD and ADs.