注意缺陷多动障碍与焦虑障碍共患病研究进展

注意缺陷多动障碍（attention-deficit hyperactivity disorder．ADHD）共患病多见，近年ADHD伴焦虑障碍渐受国内学者重视，这类儿童社会功能损害比单纯ADHD更严重．在治疗上更困难，现就其共患病机制、临床表现和治疗进行综述。     

儿童注意缺陷多动障碍治疗进展

儿童注意缺陷多动障碍(attention-deficit/hyperactivity disorder,ADHD)是儿童时期常见的行为障碍性疾病患。由于ADHD对儿童本人家庭、社会造成极大的危害,尽管病因仍未十分清楚,但及早诊断及早治疗是必需的。本文重点介绍了ADHD的治疗原则;兴奋剂,特别是长效兴奋剂在治疗中的进展;ADHD综合治疗的意义及常见共患病的治疗,以供大家参考。     

Vanderbilt父母评定量表在注意缺陷多动障碍儿童临床评估中的应用

【目的】通过将Vanderbilt父母评定量表应用于门诊中疑为注意缺陷多动障碍(attention-deficit/hyperac-tivity disorder,ADHD)的儿童,探讨该量表在辅助ADHD诊断及共患病筛查中的应用价值。【方法】2006年3月~2007年5月期间收集疑似ADHD儿童1478名,家长填写Vanderbilt父母评定量表,同时专业医生按照DSM-IV标准对儿童进行诊断,将两种方法的结果进行比较,同时根据Vanderbilt父母评定量表的结果进行共患病筛查。【结果】以DSM-IV为参照标准,Vanderbilt父母评定量表对ADHD总敏感度为90.2%,特异度为62.2%,诊断一致率为72.5%;对注意缺陷为主型的敏感度为64.9%,特异度为82.3%,诊断一致率为78.0%;对多动冲动为主型的敏感度为62.2%,特异度为90.0%,诊断一致率为88.6%;对混合型的敏感度为62.6%,特异度为88.5%,诊断一致率为86.8%。ADHD儿童中筛查出对立违抗障碍者165名,品行障碍者34名,焦虑/抑郁者21名。【结论】Vanderbilt父母评定量表对ADHD及各亚型有较好的敏感度和特异度,与DSM-IV诊断结果较符合,能提供关于常见共患病及功能损害的信息,且易于填写和评分,可用于门诊或推广至基层卫生保健机构作为评估以及获得ADHD诊断相关信息、筛查共患病的有效工具。     

孤独症谱系障碍儿童常见共患病研究进展

孤独症谱系障碍(ASD)是一组发生于生命早期的神经发育障碍性疾病,ASD儿童常伴有注意缺陷多动障碍(ADHD)、癫痫、睡眠障碍、胃肠道问题、免疫异常、焦虑、情感障碍等共患病,本文重点对目前研究较多的ASD共患ADHD、癫痫、睡眠障碍、胃肠道问题,分别从流行病学特点、对ASD儿童临床症状的影响、治疗方法方面进行综述。     

儿童多动症伴焦虑障碍的研究

注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)简称为多动症。儿童多动症中约25%伴焦虑障碍。此类儿童比单纯ADHD社会功能损害大,治疗较为困难。为了提高对儿童多动症与焦虑障碍共患病的认识,本文对其发病机制、临床表现和治疗加以综述。1多动症伴焦虑障碍     

学龄前儿童注意缺陷多动障碍的干预进展

注意缺陷多动障碍(ADHD)是儿童时期常见的神经发育障碍性疾病,以注意力不集中、多动及冲动为主要症状,在学龄前期主要表现为多动。ADHD对患儿的学业成绩、人际交往、身心发育等多方面产生严重负面影响,并可持续到青春期或成年期。早期干预可以减轻ADHD核心症状,减少共患病发生率。目前学龄前ADHD的干预手段包括行为治疗、物理治疗、药物治疗等。药物治疗可明显改善ADHD核心症状,但无法改善学龄前儿童的社交和情绪问题,且药物副反应会造成成瘾、依从性差等问题。行为治疗不仅可以改善患儿的社交功能和情绪,减轻父母养育压力,且不存在药物副作用等问题,成为当下的研究热点。本文对学龄前ADHD儿童的干预进展进行综述。     

注意缺陷多动障碍共患焦虑障碍研究概况

注意缺陷多动障碍(Attention-deficit hyperactivity disorder,ADHD)以注意力不集中、活动过度和冲动行为为主要特征,是儿童期常见的精神障碍之一.一项临床研究显示,在精神科就诊的学龄前和学龄期ADHD儿童中,近75%的ADHD儿童合并其他精神障碍[1].近年来,研究者和临床医生越来越多地关注ADHD与共患病的相互关系及其对病因学研究、诊断过程和防治策略的影响.     

注意缺陷多动障碍儿童睡眠问题的研究进展

注意缺陷多动障碍(ADHD)是儿童青少年常见的神经发育障碍性疾病,主要表现为与年龄发育不相称的注意力不集中、多动和/或冲动。ADHD易共患其他疾病,其中睡眠问题日益受到关注。患有睡眠问题的ADHD患儿可能会导致更加严重的功能障碍,影响情绪、注意力、行为,最终影响学校或者工作表现和生活质量。本文主要从ADHD患儿常见的睡眠问题、ADHD共患睡眠问题的病理机制及药物治疗对ADHD患儿睡眠的影响三个方面进行综述,以提高人们对二者之间联系的认识。     

未成年犯共患不同亚型注意缺陷多动障碍的调查研究

[目的]探讨男性未成年犯注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的患病情况、亚型分布、行为障碍类型,为早期预防未成年人犯罪提供理论依据.[方法]取在押男性未成年犯76名,采用Vanderbilt ADHD家长评定量表进行调查,诊断为ADHD的未成年犯...     

学龄阿斯伯格综合征儿童与注意缺陷多动障碍共患率调查及误诊原因分析

【目的】 调查阿斯伯格综合征(Asperger syndrome ,AS)学龄儿童注意缺陷多动障碍(attention deficit hyperactivity disorder ,ADHD)的共患率及分析其易误诊为ADHD的原因。 【方法】 应用Vanderbilt ADHD评定量表对门诊确诊的90例AS患儿(男85例,女5例)评估其ADHD的共患率,并与249例普通学龄儿童(男223例,女16例)ADHD患病率进行对比分析;曾在外院接受诊断的39例AS患儿的首诊情况,分析其误诊为ADHD的原因。 【结果】 90例AS学龄儿童中,符合ADHD诊断标准者44例(48.9%);249例普通学龄儿童中,符合ADHD诊断标准者9例(3.6%),AS病例组ADHD患病率明显高于普通学龄儿童,差异具有高度统计学意义(χ²=102.732 ,P<0.01)。在39例曾接受外院诊断的患儿中,只有6例诊断正确(占15.4%)。而误诊率高达84.6%,其中最常见的误诊为ADHD,共19例(达48.7%)。 【结论】 学龄期AS患儿ADHD的患病率显著高于正常对照组儿童,且极易误诊为ADHD。     

Mental health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder--United States, 2003

Attention-deficit/hyperactivity disorder (ADHD), previously known as attention deficit disorder, is a neurobehavioral disorder characterized by pervasive inattention and hyperactivity-impulsivity that often results in substantial functional impairment. Prevalence estimates of ADHD in school-aged children have ranged from 2% to 18% in community samples. Although stimulant medications are an effective first-line treatment for ADHD , concern persists regarding the possible side effects and long-term health outcomes associated with stimulant consumption. Estimating the number of children who have had ADHD diagnosed and are currently taking medication for the disorder is an important step toward understanding the overall burden of ADHD in the United States. Previously, population-based estimates of medication treatment for ADHD were not available or were limited by their lack of generalizability. To estimate rates of parent-reported ADHD diagnosis and medication treatment for ADHD, CDC analyzed data from the 2003 National Survey of Children's Health (NSCH). This report describes the results of that analysis, which indicated that, in 2003, approximately 4.4 million children aged 4-17 years were reported to have a history of ADHD diagnosis; of these, 2.5 million (56%) were reported to be taking medication for the disorder. Because both substantial health risks and benefits might be associated with medication treatment for ADHD, further study of this population of children with ADHD is needed.     

Substance abuse disorders in the parents of ADHD children, and parents of normal children

The objective of the study was to compare the attention-deficit/ hyperactivity, and substance abuse disorders background in the parents of children with attention-deficit/ hyperactivity disorder (ADHD), and the parents of normal children. The available sampling method was used to choose 400 parents of children (200 parents of children with ADHD and 200 parents of normal children), the ages of children were 6-18 years old. The data were collected through the Schedule for Affective Disorders and Schizophrenia (SADS) for parents and the Kiddy Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), Connors Adult ADHD Rating Scale (CAARS) and the Wender Utah Rating Scale (WURS) for adult ADHD. The results were analyzed by using SPSS-17 software, based on two-variable Chi-Square and t-tests.and P value in all disorders were equals to P<0.05. The results indicated that substance abuse in parents of children with ADHD is 21% more prevalent, and parents of children with ADHD compared to parents of normal children have 2% ADHD, 9% attention deficit disorder, and 1% hyperactivity disorder more in their background. Therefore, we conclude that there exists a significant difference between the above mentioned disorders in the parents of children with ADHD, and parents of normal children. The high prevalence rate of disorders and background of ADHD in families of individuals with ADHD shows the probability of effect of inheritance in the disorder. Also, it shows that parents of children with ADHD have more substance abuse and history of ADHD in their background.     

药物治疗对注意缺陷多动障碍患儿体格生长影响的研究进展

注意缺陷多动障碍(ADHD)是儿童时期最常见的神经发育障碍性疾病,对儿童的学业水平、人际交往、社会功能以及整个家庭、社会都有不可忽视的影响。ADHD的发病率在过去几十年里一直呈上升趋势。兴奋剂哌甲酯(MPH)与选择性去甲肾上腺素再摄取抑制剂托莫西汀(ATX)均为治疗ADHD公认的一线药物。药物对ADHD儿童体格生长可能带来的消极影响令家长担忧。本文就药物治疗对ADHD患儿体格生长的影响、相关机制及管理进行综述,以期提高患儿临床药物治疗的依从性。     

隐喻和讽刺情景测试对高功能孤独症谱系障碍与注意缺陷多动障碍的鉴别诊断意义

目的探讨高功能孤独症谱系障碍(autism spectruum disorder,ASD)儿童和注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童在隐喻和讽刺情景测试(metaphor and sarcasm scenario test,MSST)的表现特征,为二者的鉴别诊断提供依据。方法选取ASD、ADHD和对照组儿童各40名(三组年龄、智力水平均衡可比),采用修订版MSST和蜡笔盒测试进行检测和分析比较。结果 ASD与ADHD儿童在MSST中的总分、隐喻分均低于对照组(P0.01);ADHD组与对照组的讽刺分无差异,但ASD组得分明显低于对照组(P0.016 7)与ADHD组(P0.016 7);蜡笔盒测试中,ASD组通过率(65.0%)低于ADHD组(87.5%)(P0.05)。结论 ASD与ADHD儿童的隐喻理解能力均较正常儿童差,但ASD儿童表现出特异性的讽刺理解能力缺陷。因此,MSST可为鉴别ASD和ADHD提供特异性辅助依据。     

失配性负波在注意缺陷多动障碍和品行障碍患儿中的应用研究

目的了解注意缺陷多动障碍(ADHD)患儿失配性负波(MMN)的特点.方法应用美国NicoletSpirit脑电生理仪,对37例ADHD患儿、22例品行障碍患儿(CD)和30名正常儿童(NC)的MMN做了检测.结果与正常儿童对照组比较,ADHD和CD患儿MMN潜伏期均延迟.ADHD患儿波幅增高.进一步分析,ADHD组波幅又高于CD组.同时两组事件相关电位P300检测潜伏期改变方向与MMN一致.结论ADHD患儿P300变化,提示患儿可能存在注意力、记忆力缺陷及认知加工缓慢.MMN可作为P300检测的一种补充手段,而用于儿童科临床.ADHD患儿MMN潜伏期延长,提示认知功能损害.     

儿童智力和反应抑制功能分析

目的 探讨伴和不伴对立违抗障碍(ODD)的注意缺陷多动障碍(ADHD)儿童智力和反应抑制功能特点,为证明ODD是否会加重ADHD认知损害提供参考依据。方法 2015年1月-2017年11月选取符合美国精神障碍诊断与统计手册第五版(DSM-5)诊断标准的ADHD共患ODD(ADHD+ODD)、单纯ADHD(ADHD)、以及年龄、性别相匹配的正常健康儿童各30例,采用韦氏儿童智力测试第四版(WSIC-Ⅳ)对其进行智力测试,Stroop效应测试对其反应抑制功能进行评估并进行对比。结果 两病例组在智力测试方面,言语理解、工作记忆、加工速度、认知效率指数、总智商方面均落后于对照组(F=3.663、5.761、5.436、9.468、6.412,P均<0.05);ADHD+ODD组的一般能力指数落后于正常对照组(F=2.751,P<0.05);两病例组在反应抑制功能测试中的字义干扰时间均多于对照组,差异具有统计学意义(F=7.910,P<0.05);两病例组之间智力及反应抑制功能比较,差异均无统计学意义(F=2.703、0.578,P均>0.05)。结论 ADHD儿童智力及反应抑制功能均落后于正常儿童,共病ODD会加重ADHD的儿童一般能力损害,但不会加重反应抑制功能损害。     

单纯多动症与伴对立违抗患儿智力和行为比较研究

目的了解伴与不伴对立违抗障碍的注意缺陷多动障碍患儿智力和行为的差异，为制定有效的防治措施提供依据。方法采用儿童行为量表（父母问卷CBCL）和韦氏儿童智力测验（WISC—CR）对单纯多动症患儿37例和合并对立违抗障碍的多动症患儿22例进行评分和对比分析。结果注意缺陷多动合并对立违抗障碍组患儿的总智商、言语和操作智商及填图、积木、拼图3个分测验评分均低于单纯多动症组；注意缺陷多动合并对立违抗障碍患儿组行为量表违纪、攻击行为和外化性问题评分高于单纯多动症组患儿。结论注意缺陷多动合并对立违抗障碍患儿的智商较单纯多动症患儿低，提示共病组存在更为明显的大脑发育障碍。注意缺陷多动合并对立违抗障碍患儿存在更加严重的违纪、攻击及外化性行为问题。     

Current Evidence on the Role of the Gut Microbiome in ADHD Pathophysiology and Therapeutic Implications

Studies suggest that the bidirectional relationship existent between the gut microbiome (GM) and the central nervous system (CNS), or so-called the microbiome–gut–brain axis (MGBA), is involved in diverse neuropsychiatric diseases in children and adults. In pediatric age, most studies have focused on patients with autism. However, evidence of the role played by the MGBA in attention deficit/hyperactivity disorder (ADHD), the most common neurodevelopmental disorder in childhood, is still scanty and heterogeneous. This review aims to provide the current evidence on the functioning of the MGBA in pediatric patients with ADHD and the specific role of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in this interaction, as well as the potential of the GM as a therapeutic target for ADHD. We will explore: (1) the diverse communication pathways between the GM and the CNS; (2) changes in the GM composition in children and adolescents with ADHD and association with ADHD pathophysiology; (3) influence of the GM on the ω-3 PUFA imbalance characteristically found in ADHD; (4) interaction between the GM and circadian rhythm regulation, as sleep disorders are frequently comorbid with ADHD; (5) finally, we will evaluate the most recent studies on the use of probiotics in pediatric patients with ADHD.     

ADHD与TD共病儿童家庭环境特征及与个性自我意识的相关性

目的:探讨注意缺陷多动障碍(ADHD)与抽动障碍(TD)共病(CAT)患儿家庭环境特征及其与个性、自我意识之间的相关性。方法:采用家庭环境量表中文版(FES-CV)、艾森克个性问卷(少年版,EPQ)、Piers-Harris儿童自我意识量表(PHCSS)对注意缺陷多动障碍与抽动障碍共病(CAT)组60例、ADHD组79例、TD组60例、正常对照组(N组)71例儿童分别进行评估。结果:CAT组与ADHD组比较FES-CV、EPQ、PHCSS各因子得分均无明显差异,CAT组儿童在FES-CV中亲密度、知识性与组织性得分低于TD组(P<0.05),道德宗教观、知识性、娱乐性、组织性得分低于N组(P<0.05),独立性、矛盾性得分高于N组(P<0.05)。CAT组儿童精神质、神经质因子得分显著高于N组(P<0.01)。CAT组儿童行为、智力与学校情况、躯体外貌与属性、合群4个分量表得分及总分显著低于N组(P<0.01)。相关分析显示FES-CV中的矛盾性与EPQ中的掩饰程度呈负相关,道德宗教观与神经质呈负相关;FES-CV中的矛盾性与PHCSS中的行为因子呈显著负相关。结论:CAT患儿的家庭存在家庭功能缺陷,其家庭环境对患儿的个性及自我意识发展有一定的影响。     

儿童过敏性疾病与注意缺陷多动障碍的关联及相关机制研究进展

注意缺陷多动障碍(ADHD)是儿童阶段起病的神经发育障碍。近年来研究发现,其与过敏性疾病呈现高共病特点,过敏性疾病会增加儿童患ADHD的风险。二者相关性涉及复杂的神经免疫学机制:婴儿期的过敏性疾病造成的免疫失调可能影响神经发育,进而引起ADHD;ADHD也可能与过敏性哮喘等疾病涉及相似的发病机制,为累及器官在大脑的过敏性疾病。虽然大量研究认为,ADHD与神经免疫机制有关,但具体神经免疫通路有待进一步研究探索。本文对儿童过敏性疾病和ADHD关系的研究进行定性综述,并总结二者关联的机制,旨在为探索ADHD发病机制和干预方式提供新思路。