ADHD儿童亚分类与人格类型的关系

目的探讨注意力缺损多动障碍(ADHD)两个亚类型多动一冲动型和唤醒不足型与内外倾人格类型的相关性。方法从450名二～四年级小学生中筛选出ADHD儿童10名,使用艾森克人格问卷(儿童版)与“注意力障碍教师评定量表”进行测验。结果①内倾的儿重更容易表现出注意力缺损的阴性症状,以唤醒不足为主要特征。②外倾的儿童更容易表现出注意力缺损的阳性症状,以多动与冲动为主要特征。③女性儿童更容易表现出唤醒不足症状,而男性儿童则不存在这种倾向。结论内外倾人格特征的儿童在注意力障碍上有不同表现。     

北川极重灾区小学生地震后创伤症状评估

目的:了解地震半年后受灾地区小学生的心理健康状况,为进一步的干预和辅导提供依据。方法:使用儿童创伤症状量表(TSCC-A)和自编地震经历问卷对1027名北川3-6年级小学生进行评估。结果:震后小学儿童最为突出的症状倾向是焦虑,其次是抑郁和创伤后应激症状,具有地震中受伤经历、有亲人遇难、目睹亲人或他人死亡这些经历的小学生更容易出现高焦虑、高抑郁、创伤后应激障碍和高分离症状。结论:应向具有受伤、有亲人死亡、目睹了亲人或他人死亡经历的小学生提供有针对性的心理辅导和干预。     

应用“3.3.3科研体系”提高儿童学习能力的干预试点研究

观察“３．３．３科研体系”对提高儿童学习能的效能。方法：该研究介绍应用“３．３．３科研体系”对社会招生的６．５－１０．５岁学习能力障碍儿童６４例进行了３个半月的干预试验，他们多数伴有精细运动能力和手－眼－脑协调等方面的问题。结果干预后，他们的上述协调能力，学习能力等问题以及智能商均有较明显改变和提高。     

团体干预对学习障碍儿童情绪理解的影响

目的:探讨团体干预对提高学习障碍儿童情绪理解的效果。方法:将60名学习障碍儿童随机分为实验组与控制组(各30人,每组男女各半),实验组儿童接受10个星期的团体干预,通过组间比较和组内比较研究团体干预对学习障碍儿童情绪理解的影响。采用情绪理解测验考察学习障碍儿童情绪理解水平。结果:实验组和控制组学习障碍儿童团体干预后情绪理解存在显著差异,实验组儿童在表情识别、自我意识情绪识别、混合情绪识别、情绪原因理解、情绪隐藏、情绪改变理解上的得分和情绪理解总分均显著高于控制组儿童的得分。结论:团体干预能够显著提高学习障碍儿童的情绪理解水平。     

儿童注意力缺陷多动障碍与运动协调能力的关系探讨

目的探讨儿童注意力缺陷多动障碍与运动协调能力的相关性，为患儿提供个性化的综合干预方案。方法应用儿童感觉统合检核表对符合诊断注意力缺陷多动障碍的30名患儿进行测试，并检测儿童注意力。结果患儿的注意力异常与感觉统合失调为负相关，积分相关系数（r-0．66），有很强的共患关系。结论在临床治疗中除用药物、行为干预等治疗外，应配合感觉统合功能训练。     

学习障碍儿童智力与行为特征分析

目的旨在对学习障碍（LD）儿童的智力与行为特征进行更深入、细致的了解与分析,以求尽早发现儿童学习障碍及尽早实施适当的干预.方法应用中国韦氏-儿童智力量表（C-WICS）与Conner＇s父母症状问卷对学习障碍儿童与对照组各50名进行测查与比较.结果LD儿童C-WICS测试的各项分测验量表分、言语量表分、操作量表分、全量表分、及言语智商（VIQ）、操作智商（PIQ）、总智商（IQ）均显著低于对照组,且LD组VIQ显著低于PIQ;行为特征如行为问题、学习问题、心身问题、冲动-多动指数及其他项目与对照组比较在统计学上有显著性差异.结论LD儿童存在智力结构不平衡和较多的行为问题,提示内在认知特点和外在环境因素直接或间接导致儿童的学习障碍.     

小学生躯体化症状及其与述情障碍、心理虐待和忽视的关系

目的:了解小学生躯体化症状及其与述情障碍、心理虐待和忽视的关系。方法:采用儿童躯体化症状量表、多伦多述情障碍量表以及儿童心理虐待和忽视量表对长沙两所小学三至六年级的学生进行调查,收回有效问卷940份。结果:①儿童躯体化症状量表的平均得分为7.40±7.07,27.3%的儿童至少有一个经常出现或程度明显的症状,不同性别和不同年级儿童的躯体化症状检出率有显著差异;②述情障碍总分与躯体化总分的相关系数为0.32(P<0.01);③述情障碍对儿童躯体化症状的直接效应为0.39,心理虐待和忽视对儿童躯体化症状的间接效应分别为0.09和0.13。结论:①儿童躯体化症状的检出率为27.3%,其中疼痛/虚弱症状表现最为常见;②述情障碍与儿童躯体化症状之间存在低至中度相关;③述情障碍在心理虐待和忽视与儿童躯体化症状之间起完全中介作用。     

儿童焦虑障碍症状与父母养育方式的关系

目的：探讨儿童焦虑障碍症状与父母养育方式的关系。方法：采用儿童焦虑性情绪障碍筛查表（SCARED）和父母养育方式评价量表（EMBU）对329名4～6年级小学生（男生175名。女生154名）进行调查。以SCARED筛查阳性（SCARED总分≥23分）的学生为焦虑组，其余为非焦虑组。结果：在329名小学生中。SCARED筛查阳性的有59例。占总人数的17．9％，其中男23人，女36人；焦虑组双亲的“惩罚严厉”、“过分干涉“、“拒绝否认”、“过度保护”因子得分均明显高于非焦虑组，差异具有统计学意义（P〈0．01），而“情感温暖、理解”和”偏爱被试”因子得分两组间尤显著性差异（P〉0．05）：父母“惩罚严厉”、“过分干涉”、“过度保护”、“拒绝否认”因子均与焦虑症状评分存在显著正相关（P〈0．01）：多元逐步同归分析显示．“惩罚严厉”、“拒绝否认”、“过度保护”三个因子进入了回归方程，是儿童焦虑情绪的预测因素。结论：在儿童中焦虑情绪存在较普遍，儿童焦虑障碍症状与其父母养育方式关系密切。     

小学生冲动行为干预研究报告

为探讨儿童冲动行为的表现特征及干预方法，采用“ＷＨＴ心理健康诊断测验量表”结合自编“小学生冲动行为观察指标同伴提名问卷”，在１８７名有冲动倾向的学生中随机抽出２０名，分别设立辅导组和对照组，对辅导组进行为期３个月的小组辅导。结果表明，辅导组开展有目的、有计划、有针对性的干预活动，矫治有效率明显高于对照组；经辅导后的儿童冲动倾向有了明显转化。本研究结果还表明，小学生冲动行为具有一定的攻击性倾向、显著     

综合干预对受虐待小学生感觉统合能力发展的影响

目的探讨综合干预措施对小学生受虐待现象及其感觉统合能力的影响作用。方法采取整群抽样的方法对徐州市某区小学179名小学生进行儿童期虐待史自评量表（PRCA）和儿童感觉统合能力发展评定量表（SIFS）的调查。把179名小学生按班级随机分为干预组（88人）与对照组（91人）。对干预组进行2个月的综合干预,干预方法包括教师干预、家长干预、学生干预和媒体宣传。干预结束半年后,对两组小学生重测儿童期虐待史自评量表和儿童感觉统合能力发展评定量表。结果与对照组相比,干预组小学生的受虐待率下降较明显：总受虐待减少率（33.8%对20.5%,χ^25.13,P〈0.05）。重复测量的方差分析发现,综合干预后干预组触觉过分防御得分增长值显著高于对照组（P〈0.01）。回归分析表明,影响感觉统合能力得分增长值的因素有：性别、干预前感觉统合能力、是否受干预、干预后受虐待（Beta值=-0.123～-0.913,P〈0.001;Beta值=0.075～0.187,P〈0.05）,其中是否干预仅对触觉过分防御的增长值有预测作用（Beta值=0.146,P〈0.01）。结论综合干预能减少小学生受虐待现象的发生,可以促进小学生感觉统合能力的发展。     

学习障碍儿童的家庭心理环境因素

目的：探讨家庭心理环境因素对学习障碍儿童的影响。方法：按配对研究设计,采用家庭环境量表（中文版）、症状自评量表和子女教育心理控制源量表对153名学习障碍儿童及153名对照组儿童家庭特征进行调查。结果：学习障碍儿童家庭的亲密度、情感表达,成功性,知识性的评分低于对照（P＜0．05）,而家庭的矛盾性评分则高于对照组（P＜0．05）。结论：学习障碍儿童处在一个相对不良的心理环境中,提示在矫治学习障碍时,要注意家庭心理环境的改善。     

Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report

The expanding science of circadian rhythm biology and a growing literature in human clinical research on circadian rhythm sleep disorders (CRSDs) prompted the American Academy of Sleep Medicine (AASM) to convene a task force of experts to write a review of this important topic. Due to the extensive nature of the disorders covered, the review was written in two sections. The first review paper, in addition to providing a general introduction to circadian biology, addresses "exogenous" circadian rhythm sleep disorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the "endogenous" circadian rhythm sleep disorders, including advanced sleep phase disorder (ASPD), delayed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non-24-hour sleep-wake syndrome (nonentrained type) or free-running disorder (FRD). These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the AASM to present recommendations for the assessment and treatment of CRSDs based on the two accompanying comprehensive reviews. The main diagnostic tools considered include sleep logs, actigraphy, the Morningness-Eveningness Questionnaire (MEQ), circadian phase markers, and polysomnography. Use of a sleep log or diary is indicated in the assessment of patients with a suspected circadian rhythm sleep disorder (Guideline). Actigraphy is indicated to assist in evaluation of patients suspected of circadian rhythm disorders (strength of recommendation varies from "Option" to "Guideline," depending on the suspected CRSD). Polysomnography is not routinely indicated for the diagnosis of CRSDs, but may be indicated to rule out another primary sleep disorder (Standard). There is insufficient evidence to justify the use of MEQ for the routine clinical evaluation of CRSDs (Option). Circadian phase markers are useful to determine circadian phase and confirm the diagnosis of FRD in sighted and unsighted patients but there is insufficient evidence to recommend their routine use in the diagnosis of SWD, JLD, ASPD, DSPD, or ISWR (Option). Additionally, actigraphy is useful as an outcome measure in evaluating the response to treatment for CRSDs (Guideline). A range of therapeutic interventions were considered including planned sleep schedules, timed light exposure, timed melatonin doses, hypnotics, stimulants, and alerting agents. Planned or prescribed sleep schedules are indicated in SWD (Standard) and in JLD, DSPD, ASPD, ISWR (excluding elderly-demented/nursing home residents), and FRD (Option). Specifically dosed and timed light exposure is indicated for each of the circadian disorders with variable success (Option). Timed melatonin administration is indicated for JLD (Standard); SWD, DSPD, and FRD in unsighted persons (Guideline); and for ASPD, FRD in sighted individuals, and for ISWR in children with moderate to severe psychomotor retardation (Option). Hypnotic medications may be indicated to promote or improve daytime sleep among night shift workers (Guideline) and to treat jet lag-induced insomnia (Option). Stimulants may be indicated to improve alertness in JLD and SWD (Option) but may have risks that must be weighed prior to use. Modafinil may be indicated to improve alertness during the night shift for patients with SWD (Guideline).     

Parsing the Heterogeneity and Increasing Specificity: A Commentary on "Neurocognitive Functioning in Bipolar Disorder"

"Neurocognitive Functioning in Bipolar Disorder" is a comprehensive examination of the literatures examining neurocognitive and neuroimaging studies in pediatric and adult bipolar disorder. Based upon this review, the present commentary highlights four important areas of future investigation: increasing specificity of cognitive measures, evaluating the specificity of neurocognitive abnormalities to bipolar disorder, modeling heterogeneity of neurocognitive functioning within bipolar disorder, and searching for core neurocognitive processes more closely linked to the dysfunctional behavior seen in bipolar disorder. In addition to greater phenotypic clarity, attention to these four areas will be crucial for advancing the field. The present commentary provides recommendations for addressing these areas to facilitate progress in neurocognitive and neurobiological research of bipolar disorder.     

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。     

Validity of a screening test for school learning problems in a pediatric clinical setting.

Children brought to pediatric outpatient clinics with the primary complaint of developmental difficulty often arrive with little or no information as to the nature of their problem. This study sought to determine if a brief screening test could facilitate the referral process by predicting the primary diagnosis subsequently given to the child based on a comprehensive interdisciplinary evaluation. Subjects for the study were 176 English-speaking children between the ages of 5 and 11 who had been evaluated at the child development center of a large urban medical school. Of the children later diagnosed as learning handicapped, 89% failed the routing test, while 78% with other primary diagnoses passed it. The results of this preliminary study suggest that a brief screening test can be used effectively to form initial hypotheses about the problems (learning vs. nonlearning) experienced by students referred to pediatric clinics for developmental difficulties. Suggestions for further research are offered.     

Verbal memory and aspects of attentional control in children and adolescents with anxiety disorders or depressive disorders

BACKGROUND: The aim was to examine basic performance on attention and memory tasks in treatment-naive children and adolescents with anxiety disorder or depressive disorder and in healthy subjects under drug-free conditions. METHODS: Basic neurocognitive performance on attention and verbal memory tasks was examined in children and adolescents with emotional disorders, between 6 and 17 years of age. A total of 34 children with an anxiety disorder, 31 children with a depressive disorder, and 33 healthy controls were assessed with a comprehensive neuropsychological test battery. All children were treatment-naive at the time of testing. Five different computerised attention tasks and the Rey Auditory-Verbal Learning Test were administered. RESULTS: A significant effect of diagnosis was found for verbal memory but not for attention. LIMITATIONS: The large age range and inclusion of different diagnoses resulted in rather inhomogeneous groups. CONCLUSION: The present study provided evidence for an undisturbed attentional performance in both patient groups and a dissociation in memory functioning between anxious and depressed children. Memory impairment was found to be specifically associated with childhood depression.     

儿童少年双相障碍共患注意缺陷多动障碍和广泛性发育障碍的研究进展(综述)

儿童少年双相障碍共患病多,共患率高,既增加双相障碍的诊断难度,也影响双相障碍的治疗疗效,并提示更差的预后。儿童少年双相障碍共患注意缺陷多动障碍、广泛性发育障碍是近年来国外研究的热点,故本文对儿童少年双相障碍共患注意缺陷多动障碍、广泛性发育障碍的研究进展进行综述,从而有助于儿童少年双相障碍及其共患病的诊断和治疗。     

Autism (Book)

Reviewed behavioral and neuropsychological studies addressing attention-deficit disorder with (ADD/H) and: without (ADD/WO) hyperactivity. Review of the behavioral studies suggests that children with ADD/H have more behavior problems, are less popular, are more self-destructive, and are more likely to have a codiagnosis of conduct disorder. Children with ADD/WO seem more socially withdrawn, have a slower cognitive tempo, are more self-conscious, and have a higher incidence of developmental learning disorders. Neuropsychological studies suggest that children with ADD/H or ADD/WO may differ electrophysiologically and that ADD/WO children may have deficits in automaticity similar to children with learning disabilities. The literature provides more support for the diagnostic nomenclature found in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) than for the polythetic approach characterizing the diagnosis of attention-deficit hyperactivity disorder (ADHD) in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R; American Psychiatric Association, 1987).     

Obsessive fears about harm to self or others and overt aggressive behaviors in youth diagnosed with juvenile-onset bipolar disorder

BACKGROUND: Obsessive fear-of-harm, either fear of doing harm or fear of harm coming to self, may be closely associated with aggressive behaviors in juvenile-onset bipolar disorder. METHODS: We analyzed parent-report data on the Yale-Brown Obsessive Compulsive Scale (YBOCS) and Overt Aggression Scale (OAS) for 1601 children/adolescents with a clinician-assigned diagnosis of bipolar disorder. The summing of 6 YBOCS items rated "often" or "very often or almost constant" yielded a biphasic distribution of scores. Median-split was used to define meaningful subgroups contrasting high vs. low "fear-of-harm", which were then compared on parent-reported severe injury to self and others and on parent-reported suicide threats. RESULTS: High fear-of-harm was strongly associated with parent-reported severe injury to self and others. For self-injury, the estimated risk ratio for high vs. low fear-of-harm subgroups was 2.68 (95% confidence interval 1.87-3.86), indicating greater than doubling of risk associated with high fear-of-harm. For severe injury to others, the estimated risk ratio was 7.97 (95% confidence interval 4.19-15.2), suggesting a nearly eight-fold increased risk associated with high fear-of-harm. High fear-of-harm subjects were reported to make serious suicide threats much more frequently than low fear-of-harm subjects (odds ratio, estimated by ordinal logistic regression modeling methods, was 2.42 (95% CI 2.00 to 2.92; z=9.12, p<0.001). LIMITATIONS: Child report data was not obtained; clinician diagnosis was not validated via research interview. CONCLUSIONS: Obsessive fears about harm to self or others in a sample of children with a clinician-assigned diagnosis of bipolar disorder were found to be positively related to increased behavioral aggression towards self and others, as well as to frequent suicide threats.