Are foster parents reliable informants of children's behaviour problems?

BACKGROUND: Clinicians and researchers primarily measure behavioural and emotional problems of children in foster care from carer-report checklists. Yet the reliability of these reports is not adequately established. The present study examines one indicator of reliability for foster parent checklist reports: interrater agreement between foster parents and teachers. METHODS: Estimates of interrater agreement of foster parent and teacher responses on the cross-informant scales of the Child Behaviour Checklist (CBCL) and the Teacher Report Form (TRF) were obtained for 47 children in long-term foster care, aged 5-11 years. The estimates included calculations of agreement for continuous measures of problem behaviour, as well as for categorical determinations of clinically significant behaviour. RESULTS: Correlations of CBCL and TRF mean raw scores for the total problems (r = 0.71) and externalizing (r = 0.78) scales exceeded those described in prior studies of parent-teacher agreement, while correlation for internalizing scores (r = 0.23) was similar to that found previously. Teachers and foster parents demonstrated moderate to good agreement (kappa = 0.70-0.79) in identifying clinically significant total problems and externalizing problems, but poor agreement in identifying internalizing problems. CONCLUSIONS: Discrepancies between these and prior findings are discussed. For children in long-term foster care, foster parents or teachers may be used as informants for total problems, externalizing problems, and social-attention-thought problems. The reliability of data on internalizing symptoms is less certain.     

Participation in Activities Outside of School Hours in Relation to Problem Behavior and Social Skills in Middle Childhood

BACKGROUND: Research has shown that participating in activities outside of school hours is associated with lower dropout rates, enhanced school performance, improved social skills, and reduced problem behaviors. However, most prior studies have been limited to small populations of older children (>12 years). This analysis focuses on children aged 6 to 11 to assess the potential association between participation in activities outside of school hours and behavior in middle childhood in a nationally representative survey. METHODS: Estimates were based on 25,797 children from the 2003-2004 National Survey of Children's Health. Outside of school activity was defined as participating in sports teams/lessons, clubs/organizations, or both at least once in the past year. Analysis of variance was used to evaluate the differences in behavior problems and social skills adjusting for sociodemographic factors, among children classified by participation in outside of school activities. RESULTS: Seventy-five percent of children participated in outside of school activities: 23% in sports, 16% in clubs, and 36% in both clubs and sports. Activity participation differed by gender, race/ethnicity, type of school, poverty status, family structure, household education, and school and community safety. Children participating in both sports and clubs had higher social skills index scores, but no significant difference in problem behavior scores compared with children who did not participate in any outside of school activity. CONCLUSION: Children participating in both sports and clubs had greater social competence during middle childhood compared with children who did not participate in any outside of school activities.     

小学生行为问题综合干预效果评价及影响因素分析

目的探索一套治疗小学生行为问题持续有效的方法。方法抽取3～5年级有行为问题的学生85名，分成干预组（N=45名）和对照组（N=40名）。应用个体心理治疗、家庭、学校及教育等方法，集中进行持续2年的综合干预。结果干预2年后，显效率达75．56％。CBCL评定，干预组男性的分裂样、交往不良、强迫性和体诉因子分，女生的抑郁和社交退缩因子分都明显低于对照组。结论综合干预对小学生行为问题持续有效，是通过各干预方法的作用特点共同产生的效果。     

早期心理干预对产后抑郁及儿童心理发育的近远期影响研究

目的:探讨早期防治产后抑郁、促进儿童心理发育的方法和效果。方法:在围产期门诊按单、双号随机将首诊妊娠妇女分为实验组和对照组,对实验组216名孕妇进行系统心理保健,183名对照组孕妇为一般保健,采用Zung氏抑郁自评量表(SDS)监测两组妇女的情绪问题,用丹佛智能发育筛查表(DDST)监测两组儿童的智能发育,用Achenbach儿童行为量表(CBCL2～3岁家长用)评价儿童的行为发育。结果:实验组比对照组产妇产后不同时期抑郁状态的发生率(χ2=40.35～4.81,P<0.05～0.01)和抑郁症的患病率(3.7%/10.38%,χ2=7,P<0.01)均低,差异有统计学意义。两组儿童各年龄阶段DDST结果可疑和异常的人数的发生率(χ2=6.8～4.6,P<0.05～0.01)差异有统计学意义。儿童2岁时行为问题发生率差异具有统计学意义(χ2=16.3,P<0.01),儿童行为部分因子分之间差异有统计学意义(P<0.05)。入学前CBCL和感觉统合失调的发生率差异也有统计学意义(χ2=6.83,χ2=7.10,P<0.01)。结论:提示在儿童心理保健门诊对妇女进行有计划有目的的心理健康教育、情绪评定和及时的综合心理治疗,不仅有利于防治产后抑郁,对儿童近远期的生存质量、心理发育水平也有明显的促进作用。     

心理干预对广元市农村留守儿童心理行为问题的改善情况

目的 分析心理干预对改善广元市农村留守儿童心理行为问题的价值,为能进行有效干预提供指导建议。方法 2015年5月-2016年5月选取广元市农村地区具有心理行为问题[(Achenbach儿童行为量表(CBCL)任一因子大于全国常模临床界值)]的200名留守儿童,分为干预组(给予心理干预12周)、对照组(给予一般行为指导建议)各100例,对比两组儿童干预前后CBCL量表、Piers-Harri儿童自我意识量表进行心理行为问题评估。结果 干预前,干预组男童、女童和对照组男童、女童的CBCL各因子评分、Piers-Harri儿童自我意识量表评分差异无统计学意义(P均＞0.05);干预后,干预组男童、女童的CBCL各因子评分均低于对照组,差异具有统计学意义(P均<0.05),干预组Piers-Harri儿童自我意识量表评分均高于对照组,差异具有统计学意义(P均<0.05)。结论 心理干预对于改善广元市农村留守儿童心理行为问题具有显著作用,可作为一种有效的方法对农村地区留守儿童进行心理行为干预。     

Physical activity and positive youth development: impact of a school-based program

BACKGROUND: Protective factors associated with positive youth development predict health and education outcomes. This study explored trends in these protective factors and in physical activity among low‐income students, and determined the impact of a school‐based youth development program on these trends. METHODS: This study used a quasi‐experimental time series design including data from 158 low‐income schools from 2001 to 2007. Ninety‐four schools had exposure to a school‐based program promoting physical activity and youth development through structured play; 64 schools served as controls. Primary outcomes were 5th‐grade student scores (n = 13,109) on a California statewide survey for physical activity (1–6 scale) and measures of protective factors including problem solving skills, meaningful participation in school, and caring adults (1–4 scales). Predictors were time (year) and school's number of years of exposure to the program. RESULTS: Overall, significant annual declines were seen in protective factors, including students' report of feeling safe (?0.03, 95% CI [?0.03, ?0.01]), caring adults at school (?0.03 [?0.05, ?0.02]), and problem solving skills (?0.03 [?0.04, ?0.02]). Cumulative declines over 6 years were equivalent to a drop of 1 school‐level SD. Each additional year of exposure to the program predicted greater meaningful participation (0.02 [0.001, 0.5]), problem‐solving skills (0.03 [0.0001, 0.06]), and increased physical activity (0.06 [0.01, 0.10]); exposure throughout elementary school (6 years) increased scores by 1 school‐level SD. CONCLUSIONS: Low‐income students reported a significant decline in protective factors since 2001. School partnerships with youth development programs promoting physical activity may ameliorate declines in emotional well‐being and increase physical activity.     

Preventing behavior problems among elementary schoolchildren: impact of a universal school-based program in China

BACKGROUND: To evaluate the effect on problem behaviors of a universal school‐based prevention curriculum of third grade students. METHODS: Six regular classes in 1 elementary school were randomly assigned to an intervention (n = 208) or control (n = 209) group. A 13‐session program was offered to students in the intervention group. The Achenbach Child Behavior Checklist (CBCL), parent report, was used to assess problem behaviors at baseline, at the conclusion of the curriculum, and again at 6‐month follow up. RESULTS: The unadjusted mean estimates of behavioral problems were significantly lower in the intervention group posttest (at the conclusion of the curriculum), ?3.53 (95% confidence interval [CI] = ?6.59 to ?0.48; p = .023) and at the 6‐month follow up, ?5.22 (95% CI: ?8.27 to ?2.16; p = .001). After adjusting for potential confounders, gender (female), father's educational status (high school), family relationships (good and average), and child's age in months, intervention groups (intervention posttest and intervention after 6‐month follow up) showed significantly lower total behavioral scores. CONCLUSIONS: A universal school‐based prevention program for Chinese elementary school‐age children resulted in a significant positive change in behavioral problems. This is an important finding in the context of the Chinese 1‐child policy that places great value on the achievement of the child.     

中学生心理复原力自评量表的再评价

目的评价中学生心理复原力自评量表在安徽省合肥市长丰县小学四至六年级及初一至初三的在校学生中应用的可行性,为今后开展长丰县中小学生及留守儿童心理健康研究工作提供依据。方法采用整群抽样的方法抽取合肥市长丰县的3所初中和5所小学,对所抽取的全部初中生以及四、五、六年级的小学生共2655名学生进行心理复原力评定及量表的信度、效度分析。心理复原力自评量表包括6个维度,即问题解决、合作与交流、自我效能、目标与渴望、自我意识以及共情。结果心理复原力量表总分的Cronbach’sα系数为0.944,小学四到六年级及初一至初三量表得分的Cronbach’sα系数为0.932～0.947,各因子Cronbach’sα系数为0.772～0.883;量表总分的分半信度为0.874,小学四到六年级及初一至初三量表得分的分半信度为0.848～0.892;量表总分的重测信度为0.894,各因子重测信度为0.753～0.839,所有相关系数均达统计学显著性水平。采用方差最大正交旋转法因子分析产生的6个因子共解释64.532%的总方差;各项目与量表总分间的相关系数为0.434～0.717,与所属因子间的相关系数为0.683～0.876,量表总分与六个因子间的相关系数为0.692～0.846,六个因子间的相关系数为0.401～0.689,所有相关系数均达统计学显著性水平。心理复原力量表总分与抑郁相关系数为-0.493、与焦虑相关系数为-0.290,在0.01水平(双侧)上均显著相关。结论中学生心理复原力自评量表在合肥长丰县小学四到六年级及初一至初三在校学生的应用中具有较好的信度及效度,可作为该人群及其中的留守儿童一个较好的心理复原力评估工具。     

合肥市区4～6岁儿童艾氏量表得分分析

了解合肥市区４－６岁学龄前儿童艾氏行为量表的得分特征。「方法」编制儿童心理行为状况父母问卷调查表,通过分层抽样对４６１名男童和４３１名女童进行调查。「结果」男童量表总分显著高于女童;单项得分中,男童有２８项显著高于女童,６项显著低于女童,合肥市区男童忧郁、攻击两分量表划界分高于常模,女童分裂样焦虑,社会退缩两分表高于常模。     

儿童自我意识与儿童行为量表之间的关系研究

目的 了解北京某小学儿童自我意识状况,探讨儿童自我意识与儿童行为量表之间的关系。方法 采用团体施测方式对北京市某城区某普通小学3~6级学生及其家长分别使用Achenbach儿童行为量表(Child Behavior Checklist,CBCL)及Piers-Hairis儿童自我意识量表进行测查,并对调查结果进行统计分析。 结果 3~6年级的135名儿童及其家长参加了本次调查,其中男童69名,女童66名。分析结果显示男童与女童之间的自我意识水平差异无统计学意义(χ²=5.180,P=0.055)。典型相关分析显示,CBCL量表中,儿童行为得分越低(r=-0.423),社会能力分越高(r=0.803),其自我意识量表中行为(r= 0.599)及躯体外貌与属性两分量表的得分越高(r=0.777)。 结论 1)男童女童之间自我意识水平差异无统计学意义;2)儿童某些方面的自我意识状况可以通过儿童行为量表进行预测。     

Physical health,mental health,and behaviour problems among early adolescents in foster care

Background Adolescents with chronic illness in the general population are at increased risk of mental health and behaviour problems. Depression is also associated with delinquency. Adolescents in foster care are more at risk for chronic illness and mental health issues. We investigated whether adolescents in long‐term foster care with chronic illness have associated higher rates of internalizing and externalizing problems and delinquency. We also investigated if depression mediates the relationship between physical health and externalizing behaviours. Methods Data are from the National Survey of Child and Adolescent Well‐Being; adolescents age 11 and older residing in long‐term foster care (n= 188). Children whose caregivers reported on the occurrence of a chronic illness were compared using anova on internalizing and externalizing subscale scores and total scores of the Youth Self Report (YSR) and Child Behavior Checklist (CBCL), and modified Self‐Report of Delinquency (MSRD) scores of delinquency and total number of delinquent acts. Bootstrapping analyses were used to test our hypothesis that depressive symptoms (Children's Depression Inventory) function as a mediator. Results Adolescents with a chronic illness reported greater internalizing (YSR: F= 7.069, P= 0.009; CBCL: F= 4.660, P= 0.032) and externalizing (YSR: F= 5.878, P= 0.016; CBCL: F= 3.546, P= 0.061) problems, a greater number of delinquent acts (6.66, F= 5.049, P= 0.026) and heightened overall delinquency (F= 5.049, P= 0.026). Depression significantly mediated the effects of overall health on delinquency (95% CI, 0.03–1.76). Conclusions It is important to consider the complex interrelationships between physical health, mental health, and behaviour for adolescents in foster care. These findings support the need for comprehensive services for these youths, including specialized assessments and collaboration between protective services and healthcare systems.     

Medical student attitudes toward the doctor-patient relationship

CONTEXT: Medical educators have emphasized the importance of teaching patient-centred care. OBJECTIVES: To describe and quantify the attitudes of medical students towards patient-centred care and to examine: (a) the differences in these attitudes between students in early and later years of medical school; and (b) factors associated with patient-centred attitudes. METHODS: We surveyed 673 students in the first, third, and fourth years of medical school. Our survey utilized the Patient-Practitioner Orientation Scale (PPOS), a validated instrument designed to measure individual preferences towards various aspects of the doctor-patient relationship. Total PPOS scores can range from patient-centred (egalitarian, whole person oriented) to disease- or doctor-centred (paternalistic, less attuned to psychosocial issues). Additional demographic data including gender, age, ethnicity, undergraduate coursework, family medical background and specialty choice were collected from the fourth year class. RESULTS: A total of 510 students (76%) completed data collection. Female gender (P < 0.001) and earlier year of medical school (P = 0.03) were significantly associated with patient-centred attitudes. Among fourth year students (n = 89), characteristics associated with more patient-centred attitudes included female gender, European-American ethnicity, and primary-care career choice (P < 0.05 for each comparison). CONCLUSION: Despite emphasis on the need for curricula that foster patient-centred attitudes among medical students, our data suggest that students in later years of medical school have attitudes that are more doctor-centred or paternalistic compared to students in earlier years. Given the emphasis placed on patient satisfaction and patient-centred care in the current medical environment, our results warrant further research and dialogue to explore the dynamics in medical education that may foster or inhibit student attitudes toward patient-centred care.     

成渝两地专业技术人员职业紧张常模的分级标准及应用

目的　建立专业技术人员职业紧张的分级评价标准 ,并应用于实践。方法　将职业紧张常模的原始分转化为均数为 5 0 ,标准差为 10的总分 (T分 ) ,根据正态分布原理制订评价标准。结果　 (1)在职业任务和个体紧张反应问卷中 ,T≥ 70分者职业任务过重 ,紧张反应程度过高 ;T值范围在 6 0～ 6 9分者职业任务较重 ,紧张反应程度较高 ;T值在 4 0～ 5 9分者职业任务和紧张反应适度 ;T<4 0分者无职业紧张和紧张反应。应对资源问卷中 ,T <30分者显示应对资源不足 ;T值范围在 30～39分者较为缺乏应对资源 ;T值范围在 4 0～ 5 9分者具有较强的应对资源 ;T≥ 6 0分者显示有很强的应对资源。 (2 )分别制作了总体常模、男性和女性常模初分转换表 ;工程技术人员、卫生技术人员、金融业务人员、法律业务人员、教学人员、新闻出版人员常模初分转换表。根据初分转换表制作了总体得分图表、男性得分图表、女性得分图表和职业得分图表。结论　根据专业技术人员职业紧张常模 ,建立了职业紧张分级标准 ,可对个体及组织进行职业紧张程度评价、职业咨询和干预措施的选择等。     

家庭关怀及正性情绪对郑州市流动青少年心理韧性的影响

目的 了解正性情绪和家庭关怀对郑州市流动青少年学生心理韧性的影响,并分析正性情绪在两者间的中介效应,为郑州市流动青少年身心健康发展提供理论支持。方法 选取郑州市流动初中生较多的2所中学,以班级为单位随机抽取448名郑州市流动初中学生为调查对象,采用家庭关怀指数调查问卷、正性情感检核表及心理韧性量表进行问卷调查。结果 郑州市流动初中男生心理韧性得分为(93.93±18.53)分,女生为(99.93±14.08)分,差异有统计学意义(t值为-3.881,P＜0.01);郑州市流动初中学生男生的正性情绪得分为(30.36±6.11)分,女生为(29.20±4.03)分,差异有统计学意义(t值为2.394,P＜0.05)。郑州市流动初中男生的家庭关怀度得分为(4.90±2.22)分,女生为(6.01±2.33)分,差异有统计学意义(t值为-5.148,P＜0.01);。家庭关怀度及各因子与郑州市流动初中学生正性情绪和心理任性各因子间存在显著正相关关系。郑州市流动初中生的家庭关怀度对心理任性起到正向预测作用,正性情绪在家庭关怀度与心理韧性之间起到全部中介作用。结论 正性情绪在家庭关怀和心理韧性之间存在中介作用,家庭关怀通过正性情绪间接影响儿童青少年的心理韧性。     

Gender Differences in Food Preferences of School-Aged Children and Adolescents

BACKGROUND: Schools have the opportunity, through the National School Lunch Program and Local School Wellness Policies, to have a significant impact on healthy eating behaviors. An understanding of children's and adolescents' food preferences in relation to gender and age will facilitate the successful creation of both healthy and financially viable school menus. The purpose of this study was to identify food preferences with respect to gender of school-age children and adolescents in an Ohio school district.
METHODS: A survey was administered to 1818 3rd- to 12th-grade students in 1 rural northeast Ohio school district. Students filled out an anonymous questionnaire about their preferences for 80 different foods using a 5-point rating scale. The student data were grouped according to school level attended: elementary (3rd-6th), middle (7th-8th), and high school (9th-12th). An exploratory factor analysis identified entrée and side dish factors. Cronbach's alpha was used to measure each factor's internal reliability. Differences in mean scores by gender and grade for each of the entrée and side dish factors by gender and grade were identified using analysis of variance (ANOVA).
RESULTS: Boys preferred the meat, fish, and poultry foods over girls; girls preferred fruits and vegetables over boys (p < .05). Furthermore, gender differences in preferences were also demonstrated with respect to school level.
CONCLUSIONS: Food preferences differed between genders and these gender differences varied among elementary, middle, and high school students. Gender differences should be considered when providing food choices to boys and girls at all ages.     

优质护理服务病房护士职业倦怠与心理契约的相关性分析

目的：探讨优质护理服务病房的护士职业倦怠与其心理契约的相关性。方法：采用职业倦怠量表和心理契约量表对浙江省某医院优质护理服务病房的护士进行问卷调查,并与普通病房护士作对照。结果：①优质护理组职业倦怠量表中的情绪衰竭（EE）和去个性化（DP）评分以及心理契约量表中的发展机会评分显著高于对照组,差异均有统计学意义（P〈0.05）;优质护理组职业倦怠量表中的个人成就感丧失（PA）评分以及心理契约量表中的物质激励、环境支持评分均显著低于对照组,差异均有统计学意义（P〈0.05）;②优质护理组心理契约量表中的物质激励和环境支持与职业倦怠量表中各维度评分均显著负相关（P〈0.05）;对照组中心理契约量表中的物质激励与职业倦怠量表中的各维度得分均显著负相关（P〈0.05）。结论：优质护理服务病房护士虽将开展优质护理服务视为发展机会,并具有一定的成就感,然而医院物质激励和环境支持责任履行程度不高,严重影响其职业倦怠水平。     

Daughters and mothers exercising together (DAMET): a 12-week pilot project designed to improve physical self-perception and increase recreational physical activity.

This paper presents the results of a 12-week single-sex, family-based physical activity intervention grounded in Social Cognitive Theory. Mother/daughter pairs and triads (n = 20) attended physical activity and classroom sessions twice weekly. Physiological data (VO2peak, height, and weight), psychological data (physical self-perception profile subscale scores), information about physical activity participation (PAP, d x wk(-1)) and qualitative impressions (QI) of the program were collected pre- and post-intervention. PAP and QI were also collected 6-months after completing the intervention. Although no significant increases in physical activity were reported, significant improvements in perceived sport competence, physical condition, and strength and muscularity were reported over time. The social cognitive theory, as used to plan this physical activity intervention, offered a promising theoretical perspective for facilitating improved physical self-perception in adolescent girls and their mothers.     

Perceived competence and school adjustment of hearing impaired children in mainstream primary school settings

Background Although educational main streaming of children with special needs formally began in Iran since 1992 there is little information whether hearing impaired children feel competent in regular schools. Methods To determine the perceived competence and school adjustment of hearing impaired children in mainstream primary school settings, the self‐perception profile was administered to 60 mainstreamed hard of hearing children and 60 classmates with normal hearing matched for gender by a single interviewer. The instrument comprised 28 items, 23 of which were similar to those of ‘adapted test Image for children with cochlear implants' asking children about their feelings about their own cognitive, physical, socio‐emotional and communication competence and school adjustment. The Cronbach alpha coefficient for the instrument was 0.93. Results Hard of hearing children rated their competence significantly poorer than their hearing classmates for all domains. Mean differences for the five domains ranged from 0.48 (for physical competence) to 0.90 (for school adjustment) on a scale of 1–4. There were no significant differences between girls' and boys' competence, in either the hearing or the hearing impaired groups. Classifying overall scores for perceived competence into four groups (‘poor competence’, ‘low competence’, ‘moderate competence’ and ‘high competence’), 23.4% of hearing impaired children but none of the hearing classmates rated themselves as having low or poor competence. On the other hand 85% of hearing children and only 18.3% of hearing impaired children rated themselves as highly competent. Conclusion We suggest that periodical assessments of mainstreamed children might help to identify those children who are having difficulty adapting to their environment.     

2~3岁儿童行为问题调查和早期干预效果评价

目的:了解佛山市2~3岁儿童行为问题发生特点,研究社区儿童心理卫生综合干预措施的干预效果。方法:采用整群抽样的方法将所研究的社区儿童分为干预组和对照组,干预组采取儿童心理卫生综合心理措施。干预1年后用CBCL量表对适龄儿童进行调查,其中干预组儿童235人,对照组适龄儿童389名。结果:对照组儿童行为问题检出率为29.4%,干预组为22.6%;干预组儿童6个行为因子的粗分低于对照组,其中抑郁、睡眠、攻击和破坏4因子的组间差异有统计学意义;在有行为问题的儿童中,干预组和对照组在内向、外向型问题的内部构成亦不同。结论:对2~3岁儿童进行早期心理干预可以取得明确的近期效果。     

首发儿童精神分裂症患者行为特征与颅脑结构的关系

探讨首发儿童精神分裂症患者行为特征与颅脑结构的差异,为儿童精神分裂症的早期发现及预防提供依据.方法 根据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)精神分裂症的诊断标准,选取在新乡医学院第二附属医院住院就诊的96例首发儿童精神分裂症患儿为病例组,以49名正常儿童为对照组1,100名正常儿童为对照组2.采用3.0 T磁共振成像(MRI)检测对照组1及病例组儿童的颅脑结构,用Achenbach儿童行为量表(CBCL)回顾性评估所有对照组2及病例组611岁儿童的行为特征.结果 病例组儿童的第三脑室横径及侧脑室前脚均高于对照组1(t值分别为3.00,2.13,P值均<0.05),胼胝体体部厚度、尾状核头部宽度、海马厚度均低于对照组1(t值分别为-2.44,-7.68,-5.07,P值均<0.05).病例组的社会能力总分及学校情况因子分均低于对照组2(t/Z值分别为-4.30,4.85,P值均<0.01),行为问题总分及社交退缩、分裂强迫、攻击因子分均高于对照组2(Z值分别为3.00,2.56,2.75,3.66,P值均<0.05).社会能力总分与胼胝体体部厚度、扣带回、尾状核体部长度、海马宽度及海马厚度均呈正相关;行为问题总分与尾状核体部长度及海马宽度均呈负相关(P值均<0.05).结论 首发儿童精神分裂症患者病前存在较低的社会能力及较多的行为问题,患病后存在脑室扩大和颅脑结构异常;患病前社会能力越低或行为问题越多,患病后脑室扩大和颅脑结构异常越明显.