整合视听连续执行测试与儿童感觉统合能力的相关性分析

目的：通过整合视听连续执行测试和儿童感觉统合能力评定，探讨二者之间的相关性及各亚型ADHD儿童的感觉统合能力的差异。方法：根据整合视听连续执行测试结果将170名儿童分成4组，对各组儿童进行感觉统合能力评定。结果：注意缺陷为主型儿童的视觉反应控制商数与本体感及身体协调因子分呈负相关；多动-冲动为主型儿童的综合尺度反应控制商数、视觉反应控制商数、综合尺度注意力商数、听觉注意力商数与学习能力发展因子分呈正相关；混合型儿童的综合尺度注意力商数、视觉注意力商数与学习能力发展因子分呈正相关；注意缺陷为主型和混合型儿童的大肌肉及平衡感、学习能力发展因子分低于临界值；多动-冲动为主型儿童的学习能力发展因子分低于临界值．触觉防御及情绪因子分高于临界值；其他各项因子分接近临界值。结论：根据整合视听连续执行测试结果诊断的ADHD各亚型的综合商数与感觉统合能力发展评定量表因子分的相关性是不同的；各亚型ADHD儿童的感觉统合能力均较低，且都存在着学习能力发展不足问题；注意缺陷为主型和混合型儿童的大肌肉及平衡感失调比多动-冲动为主型儿童更明显。     

注意缺陷多动障碍儿童持续性注意测验的对照研究

目的：了解不同持续性注意测验对注意缺陷多动障碍儿童注意障碍的评定。方法：符合DSM－Ⅳ注意缺陷多动障碍的113名男性儿童与83名正常对照儿童分别采用视觉单目标持续性注意测验、视觉连续目标持续性注意测验和听觉持续性注意测验进行对照研究。结果：混合型儿童的视觉单目标持续性注意测验的击中率低于对照组，听觉持续注意测验的ADHD各亚型的击中率，d‘值、β值均低于对照组儿童，ADHD各亚型的虚报率高于对照组。结论：ADHD各亚型儿童存在明显的听觉持续性注意能力损害。     

共患对立违抗性障碍的注意缺陷多动障碍儿童的认知特点研究

目的:探讨共患对立违抗性障碍(ODD)的注意缺陷多动障碍(ADHD)儿童的认知功能特点.方法:以单纯ADHD ODD、单纯ADHD和正常儿童各36例(性别、年龄与ADHD亚型组间匹配)为研究对象,采用龚耀先修订的韦氏儿童智力量表、韦氏记忆量表、数字划消、Stroop测验和瑞文标准推理测验对其智力、记忆力、注意力水平及执行功能进行评定.结果:两病例组的常识、类同、译码、言语智商、操作智商、全量表智商、A因子、C因子、经历定向、心智、再生、触觉、长时记忆、短时记忆、记忆商、瑞文标准推理测验标准分、Stroop测验A完成时间、C完成时间和总完成时间的测验成绩与正常对照组的差异具有显著性,两病例组间差异无显著性;正常组数字划消测验总分有显著高于两病例组(F＝2.521,P＝0.093)及平均失误率显著低于两病例组的趋势(χ2＝5.150,P＝0.076);ADHD组和正常对照组在算术、数字广度、积木、B因子、Stroop测验B完成时间和D完成时间上的差异具有显著性;ADHD ODD组的瑞文标准推理测验标准分有优于ADHD组的趋势(Z=-1.674,P=0.094).结论:伴或不伴ODD的ADHD儿童有着相似的认知模式,如扩大样本量,可能发现共患病组在某些认知功能上与纯ADHD组的差异.     

注意缺陷多动障碍儿童感觉统合与执行功能的相关分析

目的：探讨注意缺陷多动障碍(ADHD)儿童感觉统合与执行功能之间的关系。方法：对282例符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)ADHD诊断标准的门诊儿童，进行感觉统合功能和执行功能评定，对结果进行相关性分析。结果：感觉统合功能量表中，大肌肉及平衡能力的等级评分与Stroop测验的A反应时、总反应时呈正相关，与韦氏记忆中倒背数字得分呈负相关；触觉过度防御及情绪不稳的等级评分与Stroop测验的C错误数和色干扰呈负相关；本体感不佳、身体协调不良的等级评分与Stroop测验的C错误数和总错误数呈负相关；学习能力发展不足或协调不良的等级评分与Stroop测验的D反应时、总反应时、D错误数、总错误数以及瑞文标准推理测验的标准等级分呈正相关；大年龄的特殊问题的等级评分与Stroop测验的C错误数、D错误数、总错误数呈负相关。结论：ADHD儿童感觉统合功能，尤其是大肌肉和平衡能力、学习能力发展不足或协调不良与执行功能有关；ADHD儿童的感统失调，尤其是前庭网状结构功能失调引起的注意力损害,多动和冲动,与患儿的行功能缺陷有密切的联系．     

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。     

注意缺陷多动障碍患儿执行功能特征

目的:探讨注意缺陷多动障碍患儿的执行功能特征。方法:符合DSM-Ⅳ诊断标准的ADHD儿童114名,正常对照组76名。采用威斯康星分类卡片测验、持续性操作测验、STROOP字色干扰测验评定其执行功能。结果:WCST测验ADHD组总应答数、完成第一个分类所需应答数和持续性应答数得分均高于正常对照组(P0.05);而其完成分类数、正确思考时间和不能维持完整分类数得分均显著低于正常对照组(P0.01);CPT测验ADHD组错误数和漏报数得分均明显高于正常对照组(P0.01);STROOP测验ADHD组色词阅读错误数、颜色命名错误数和颜色干扰命名错误数得分均明显高于正常对照组(P0.01);差异均具有统计学意义。结论:ADHD患儿存在执行功能的缺陷,以持续性注意缺陷、行为抑制为主要特征。     

注意缺陷多动障碍儿童执行功能特征

目的:探讨注意缺陷多动障碍(ADHD)儿童执行功能的特征。方法:采用Stroop效应、视觉和听觉Go/No-Go反应、倒背数字、延缓期的空间位置记忆广度、伦敦塔任务和连线测验分别测试40例ADHD儿童和25例正常对照组儿童的反应抑制、语音工作记忆、视空间工作记忆、计划能力和定势转移能力。结果:1.ADHD儿童完成字义与字色相矛盾的字色命名时间较正常对照组儿童明显延长(P﹤0.05)。2.ADHD儿童完成视觉和听觉的Go/No-Go反应所犯错误数均较正常对照组儿童明显增多(P﹤0.01)。3.ADHD儿童倒背数字分数和延缓期的空间位置记忆广度均较正常对照组儿童明显低(P﹤0.01)。4.ADHD儿童完成两步、四步和五步伦敦塔任务的时间均较正常对照组儿童明显延长、犯错误数明显增多(P﹤0.05);而完成四步、五步伦敦塔任务的最初计划时间则较正常对照组儿童明显缩短(P﹤0.01)。5.ADHD儿童完成连线测验甲式的时间和犯错误数与正常对照组儿童无显著性差异(P﹥0.05),而完成乙式所需时间则较正常对照组儿童明显延长、犯错误数较正常对照组儿童明显增多(P﹤0.05)。结论:ADHD儿童存在反应抑制、语音工作记忆、视空间工作记忆、计划能力和定势转移能力等多项执行功能的缺陷。     

学龄Asperger综合症儿童的注意缺陷与多动症状

目的:分析比较学龄Asperger综合症儿童中的注意缺陷与多动症状。方法:应用Conner's父母用症状问卷、视听整合连续执行测试(IVA-CPT)分别对28例Asperger综合症儿童、30例注意缺陷伴多动障碍儿童以及30例正常儿童的注意缺陷及多动症状进行比较。结果:Asperger综合症儿童有60.7%同时伴有注意缺陷与多动症状;伴注意缺陷及多动症状的Asperger综合症儿童与ADHD儿童相比更多地表现为注意缺陷为主型(52.9%对20.0%,χ2=7.208,P=0.027);AS儿童的品行问题、学习问题、冲动-多动以及多动指数因子分高于正常对照组(0.89±0.44/0.50±0.26,1.67±0.52/0.88±0.50,1.40±0.71/0.68±0.41,1.40±0.57/0.59±0.36,P<0.05);AS儿童的总注意商数、总反应控制商数得分低于正常对照(77.7±23.6/100.2±20.0,P<0.05);AS儿童的总反应控制商数高于ADHD儿童(92.1±21.1/104.6±11.3,P<0.05)。结论:本研究支持Asperger综合症与注意缺陷及多动症状高相关性的观点,建议在对As-perger综合症儿童进行心理评估和制定干预计划时中需将该因素考虑在内。。     

初诊ADHD儿童的执行功能研究

目的探讨注意缺陷多动障碍(ADHD)儿童的执行功能特点。方法运用注意网络测试、数字广度及数字颜色连线实验分别对符合DSM-Ⅳ诊断标准的50例ADHD患儿(ADHD组)和50名健康儿童(HC组)进行执行功能研究。结果 ADHD组的注意网络测试(ANT)冲突监控网络效率[84.00(59.75,120.50)ms]低于HC组[70.50(63.00,78.00)ms],差异有统计学意义(z=-2.451,P=0.014);而两组的警觉、定向网络效率差异均无统计学意义(P0.05)。与HC组相比,ADHD组的数字倒背得分明显减低(3.80±0.70),完成数字颜色连线测验Ⅱ所需时间延长(197.34±73.37s),差异有统计学意义(P0.05)。数字正背及连线测验Ⅰ结果差异无统计学意义(P0.05)。结论 ADHD患儿存在冲突监控、工作记忆及注意转换等方面的执行功能损害。     

慢性抽动障碍儿童行为问题的对照研究

目的:比较伴与不伴注意缺陷多动障碍(ADHD)的慢性抽动障碍(CTD)儿童和ADHD以及正常对照儿童行为问题的差异。方法:对伴与不伴ADHD的CTD儿童和ADHD以及正常对照儿童采用儿童行为量表(CBCL)进行对比分析。结果:CTD ADHD组和ADHD组儿童总的行为问题发生率、CBCL多数因子分及行为问题总分与单纯CTD组和对照组比较,差异有统计学意义(P﹤0.05),而单纯CTD组和对照组两组间只有强迫、多动、攻击因子分和行为问题总分有统计学差异(P﹤0.05)。结论:伴有ADHD的CTD儿童与ADHD儿童相似,存在较高的行为问题发生率和较多的行为问题,提示伴有的ADHD是CTD儿童行为问题的主要来源。     

注意缺陷多动障碍临床亚型持续性注意力的比较

目的：比较注意缺陷多动障碍不同临床亚型儿童持续性注意力的差异。方法：符合DSM—Ⅳ注意缺陷多动障碍的90名儿童，分为注意缺陷为主型（ADHD—PI；44例）、多动-冲动为主型（ADHD—HI；14例）、混合型（ADHD—CT；36例），对3组患儿进行视听整合持续性操作测试，对视觉和听觉持续性注意力进行组间比较。结果：混合型和注意缺陷为主型的持续性注意力低于多动-冲动型，差异有统计学意义。结论：持续性注意力的损害以混合型最重，多动-冲动为主型最轻。     

Learning disabilities and executive dysfunction in boys with attention-deficit/hyperactivity disorder

The effect of comorbid reading or arithmetic learning disabilities (LDs) on neuropsychological function in attention-deficit/hyperactivity disorder (ADHD) was studied. Participants were young males diagnosed with ADHD, with and without LD, and non-ADHD, non-LD male controls of similar age. LD was defined by combined regression-based and low-achievement classifications. Analyses adjusted for the effect of psychiatric comorbidity, age, and socioeconomic status on neuropsychological function. Children who had both ADHD and LD were significantly more impaired on both executive and nonexecutive functions than ADHD children without LD. Neuropsychological performance was most impaired in ADHD with combined arithmetic and reading disability. These data indicate that comorbid LD, especially arithmetic disability, significantly increases the severity of executive function impairment in ADHD.     

视听整合持续测试的诊断价值

目的探讨视听整合持续测试（IVA-CPT）在儿童注意缺陷多动障碍（attention deficit hyperactivity disorder ADHD）辅助诊断中的评估价值。方法应用IVA-CPT操作评估软件对一组符合DSM-诊断标准的多动症儿童和一些正常儿童进行测试。结果根据DSM-诊断标准,76例ADHD患儿经IVA-CPT测试,结果异常,符合临床诊断的有69例,敏感度为90.79%;40例正常儿童中结果有异常的5例,特异度为87.5%;假阴性率为9.11%;假阳性率为12.5%。结论IVA-CPT是客观、标准、高精确度的持续性操作测试,在ADHD诊断中有较理想的辅助诊断意义,值得推广应用。     

注意缺陷多动障碍儿童记忆和学习的研究

目的：探讨注意缺陷多动障碍DSM－Ⅳ亚型记忆学习功能及与持续性注意的关系。方法：对113名8－12岁注意缺陷我动障碍男童与83名正常儿童对照研究，并与持续性注意测验进行相关分析。结果：ADHD各亚型图案记忆成绩均较对照组差；混合型儿童的图片记忆，言语记忆和故事记忆成绩较对照组差。持续性注意测验的击中度，虚报数，d‘值与记忆和学习相关。结论：注意缺陷多动障碍儿童存在记忆与学习功能损害，与注意障碍明显相关。     

Learning styles of LD and NLD ADHD children.

Attention Deficit Hyperactive Disorder (ADHD) children (N = 26) with a learning disability (LD) and without (NLD) were compared on measures of information processing using the Learning Efficiency Test (LET). Method of presentation (visual vs. auditory), order of recall (ordered vs. non-ordered), and memory processes (immediate, short-term, and long-term) were assessed. While both groups showed more difficulty with short-term and long-term memory processes than with immediate memory processes, the ADHD-LD subjects demonstrated more difficulty processing information effectively. Ordered recall was significantly more difficult for both short-term and long-term memory processes than was unordered recall. While both groups demonstrated difficulty with auditory ordered recall under short-term and long-term conditions, the ADHD-LD subjects lost the most information under auditory conditions.     

Attention deficit and learning disabilities (ADHD/LD) among high school pupils in Holon (Israel)

Five hundred forty-three students participated in the study. The prevalence of ADHD according to criteria of DSM-4 among them was 15.2%, including three subgroups: ADHD (inattentive)- 9.7%, combined- 4.5%, and ADHD-hyperactivity-impulsivity (HI)- 1%. The prevalence of learning disability (LD) was 17.6%. The gender ratio in both groups (ADHD and LD) was equal. These pupils had lower academic achievements with lower marks. The prevalence of ADHD/LD found in the present study in Israel is in a higher range of those reported in the literature. We should remember that ADHD/LD is a neuro-behavioral disability and these children and adolescents need an early educational correcting program at home and at school.     

Additive effect of three noradrenergic genes (ADRA2A, ADRA2C, DBH) on attention-deficit hyperactivity disorder and learning disabilities in Tourette syndrome subjects

Halperin et al. (Halperin JM. Newcorn JH, Koda VH, Pick L, McKay KE, Knott P. Noradrenergic mechanisms in ADHD children with and without reading disabilities: a replication and extension. J Am Acad Child Adolesc Psychiatry 1997: 36: 1688 1696) reported a significant increase in plasma norepinephrine (NE) in attention-deficit hyperactivity disorder (ADHD) children with reading and other cognitive disabilities compared to ADHD children without learning disabilities (LD). We examined the hypothesis that ADHD + LD was associated with NE dysfunction at a molecular genetic level by testing for associations and additive effects between polymorphisms at three noradrenergic genes the adrenergic alpha2A receptor (ADRA2A), adrenergic alpha2C receptor (ADRA2C), and dopamine beta-hydroxylase (DBH) genes. A total of 336 subjects consisting of 274 individuals with Tourette syndrome (TS) and 62 normal controls were genotyped. Regression analysis showed a significant correlation between scores for ADHD, a history of LD, and poor grade-school academic performance that was greatest for the additive effect of all three genes. Combined, these three genes accounted for 3.5% of the variance of the ADHD score (p = 0.0005). There was a significant increase in the number of variant NE genes progressing from subjects without ADHD (A-) or learning disorders (LD-) to A + LD - to A - LD + to A + LD + (p = 0.0017), but no comparable effect for dopamine genes. These data support an association between NE genes and ADHD, especially in ADHD + LD subjects.     

BAIAP2基因多态与儿童注意缺陷多动障碍共患学习困难的关联分析

目的:探讨脑特异性血管发生抑制剂1相关蛋白2(BAIAP2)基因多态与儿童注意缺陷多动障碍(ADHD)共患学习困难(LD)的关联。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准731例共患LD的ADHD儿童和957例健康对照,采用高通量实时荧光定量PCR方法检测基因型,探讨BAIAP2基因的9个单核苷酸多态性(SNPs)位点与共患LD的儿童ADHD的关联。结果:BAIAP2的SNP位点rs8079626/G(病例对照频率0.638 vs.0.604)和rs4969385/T(0.179 vs.0.150)与儿童ADHD共患LD关联,rs3934492/C(0.572 vs.0.532)和rs4969385/T(0.180 vs.0.142)与男性儿童ADHD共患LD关联,rs4969239/G(0.426 vs.0.329)和rs4969358/A(0.472 vs.0.389)与女性儿童ADHD共患LD关联(均P0.05);由rs4969239-rs4969358-rs6565531-rs8079626组成的单体型AAGG与共患LD的儿童ADHD共患LD(0.100 vs.0.065)和男性儿童ADHD共患LD(0.101 vs.0.065)关联(均P0.05)。结论:BAIAP2基因多态性可能与汉族儿童ADHD共患LD的病理机制有关,且这种作用机制可能存在性别差异。     

Attitude and knowledge of attention deficit hyperactivity disorder and learning disability among high school teachers

The aims of the study were to investigate teachers’ knowledge and attitudes towards attention deficit hyperactivity disorder (ADHD) and learning disabilities (LD). Forty-six high school teachers were interviewed in this regard. The 46 teachers were divided into two groups: 25 teachers taught at an academic school (School 1); and 21 teachers taught at special education school (School 2) and dealt with ADHD/LD cases regularly. General knowledge about ADHD (71%) and about LD (74%) was relatively low among both groups. Thirteen percent of all teachers considered LD to be the result of parental attitudes, namely ‘spoiling’ the children. The score for attitude and understanding of ADHD children was relatively low (72.5%) for both groups, whereas Group B teachers scored higher regarding LD cases. Almost 40% considered that ADHD children should be rebuked and/or punished in a manner similar to non-ADHD kids. Regarding long-term outcome, 45.7% of the teachers expected ADHD children to experience multiple difficulties in family life during adulthood. In relation to LD cases, the overall scoring for positive attitude was 75%. However, this score was higher for Group B teachers. Three-quarters of the teachers favored increasing peer awareness and comprehension as to the problems LD kids encounter at school. Ninety-five percent believed LD patients should enjoy a more lenient school education. There was no correlation between teachers, knowledge of ADHD and LD and their attitude. The main sources for this knowledge were: specialized textbooks, continuous education, TV shows, journals and newspapers, and medical personnel.