儿童注意缺陷多动障碍症状伴焦虑症状发生的调节中介因素研究

目的 探讨儿童注意缺陷多动障碍（ADHD）症状伴焦虑症状发生的调节中介因素。方法 共纳入12 271名小学生,年龄8.9±1.9岁,其中男生6 743名,女生5 508名,性别缺失20名。采用心理创伤问卷（父母版）和Conners父母用量表收集学生相关资料,问卷由学生父母填写。采用单因素分析、多因素分析和调节中介分析法处理数据。结果 单因素分析结果显示,总样本及男性和女性儿童的多动指数因子和儿童期创伤分别与焦虑因子呈正相关（P < 0.01）,ADHD和儿童期创伤正向预测焦虑障碍（P < 0.001）。多因素分析结果显示,总样本、男性和女性儿童的多动指数因子（ADHD症状）和儿童期创伤正向预测焦虑因子得分（P < 0.001）,ADHD和儿童期创伤正向预测焦虑障碍（P < 0.001）。调节中介分析结果显示,男性和女性的儿童期创伤是多动指数因子与焦虑因子间的中介因素（P < 0.05）,性别在多动指数因子与焦虑因子之间起调节作用（P < 0.001）。结论 ADHD症状/ADHD与焦虑症状/焦虑障碍关系密切。儿童期创伤在ADHD症状与焦虑症状间起中介作用,性别在ADHD症状与焦虑症状间起调节作用。     

睡眠质量对注意缺陷多动障碍儿童症状的影响:工作记忆的中介作用北大核心CSCD

目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童工作记忆在睡眠质量与症状之间的中介作用。方法采用随机整群抽样法从新疆维吾尔自治区喀什市2所小学3~5年级学生中筛选出符合条件的ADHD儿童(110例)及正常对照儿童(124例)为研究对象,采用SNAP-Ⅳ评估量表、匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)、工作记忆任务测试进行调查并比较。结果ADHD组儿童主观睡眠质量、入睡时间、睡眠效率、睡眠障碍评分及PSQI总分高于正常对照组(P<0.001),睡眠质量问题的发生率也高于正常对照组(P<0.001);ADHD儿童工作记忆得分低于正常对照组(P<0.001)。ADHD组工作记忆得分与PSQI总分呈负相关(r_(s)=-0.271,P<0.001),与症状得分呈负相关(r_(s)=-0.439,P<0.001);ADHD组PSQI总分与症状得分呈正相关(r_(s)=0.540,P<0.001)。工作记忆在睡眠质量对ADHD儿童症状影响中起部分中介效应,占总效应的18.10%。结论部分ADHD儿童存在睡眠质量问题,且工作记忆在ADHD儿童睡眠质量与症状之间起中介作用。     

家庭阅读环境与儿童情绪调节能力的关系:亲子关系的中介作用北大核心CSCD

目的研究家庭阅读环境对儿童情绪调节能力的影响及亲子关系在二者间的中介作用。方法通过分层整群抽样法抽取南京市5所幼儿园学龄前儿童1626名,通过问卷调查收集家庭阅读环境、儿童情绪调节、亲子关系等信息,使用SPSS宏中的Process程序建立中介作用模型,采用Bootstrap法检验中介效应的显著性。结果家庭阅读环境与儿童情绪调节能力(r=0.217,P<0.001)和亲子亲密性(r=0.065,P<0.01)呈正相关,与亲子冲突性呈负相关(r=-0.129,P<0.001);亲子冲突性与儿童情绪调节能力呈负相关(r=-0.443,P<0.001),亲子亲密性与情绪调节能力呈正相关(r=0.247,P<0.001)。家庭阅读环境对儿童情绪调节有显著的直接效应(β=0.162,P<0.001),亲子关系的中介效应占总效应的25.54%。结论家庭阅读环境可影响儿童情绪调节能力的发展,且亲子关系在家庭阅读环境和儿童情绪调节能力发展之间起中介作用。     

注意缺陷多动障碍儿童的体格生长和膳食特征：一项横断面研究

目的 调查注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童的体格生长及膳食特征,并分析其与ADHD核心症状的关系。方法 纳入2020年6—12月在南京医科大学附属儿童医院初诊为ADHD的患儿268例(ADHD组),另选取同期健康体检的非ADHD儿童102例作为对照组。对两组儿童进行体格测评、膳食调查,并依据美国精神障碍诊断与统计手册第5版进行ADHD诊断及评分,采用因子分析、Spearman秩相关分析及中介效应分析评估ADHD核心症状、膳食模式及体格生长之间的关系。结果 ADHD组超重/肥胖检出比例显著高于对照组(35.8%vs 21.6%,P<0.05)。依据食物频率问卷共提取3种膳食模式:素食膳食模式、传统膳食模式及零食快餐模式。其中ADHD组儿童零食快餐模式因子得分高于对照组(P<0.05)。ADHD症状评分、零食快餐模式因子得分及体脂百分比两两之间呈显著正相关(P<0.05)。中介效应分析显示,零食快餐模式因子得分在ADHD症状评分与体脂百分比的关系中起到了部分中介作用,中介占比为26.66%。...     

听处理与学龄前儿童问题行为的关系：执行功能的中介作用

目的 探讨学龄前儿童听处理与问题行为的关系,并探究执行功能在其中的中介作用。方法 于2021年6—8月抽取南京2 342名7所幼儿园学龄前儿童,用《学龄前儿童听处理评估量表》《Conners父母问卷》《学龄前儿童执行功能行为评定问卷》对学龄前儿童进行评估,分析不同人口学特征儿童听处理、问题行为、执行功能的得分以及异常检出率的差异,同时采用多元线性回归分析影响儿童听处理总分、问题行为总分、执行功能总分的影响因素,并探究执行功能是否是听处理和执行功能的中介因素。结果 性别、年级是听处理总分的影响因素(P<0.05);性别、年级、父母受教育程度及家庭经济状况是问题行为总分、执行功能总分的影响因素(P<0.05)。听处理总分(rs=0.458,P<0.05)、问题行为总分(rs=0.185,P<0.05)与执行功能总分呈显著正相关,听处理总分与问题行为总分呈显著正相关(rs=0.423,P<0.05)。执行功能在听处理与问题行为间起部分中介作用,中介效应占总效应的33.44%。结论 学龄前儿童听处理可能直接影响其问题行为,也可能通过间接影响执行功能影响问题行为。[...     

注意缺陷多动障碍儿童焦虑抑郁情绪研究

目的探讨注意缺陷多动障碍(ADHD)儿童情绪问题。方法ADHD儿童70例与对照组儿童45例分别自行完成儿童焦虑性情绪障碍筛查表、儿童抑郁障碍自评量表。结果ADHD组儿童躯体化/惊恐、广泛性焦虑、分离性焦虑、学校恐怖及焦虑、抑郁总分均高于对照组(P均<0.05)。结论ADHD组儿童存在明显焦虑、抑郁情绪。     

家长培训合并哌醋甲酯治疗对注意缺陷多动症障碍患儿家庭关系的影响

目的 了解家长培训合并哌醋甲酯治疗对注意缺陷多动障碍（ADHD）患儿家庭关系的干预效果。方法 对59 例ADHD 患儿家长进行为期5 周的家长培训,在培训前后使用Conners 儿童行为问卷（父母用）、ADHD 和对立违抗障碍（ODD）症状分级父母评量表、照料者压力问卷、亲子关系自评量表、儿童自我意识量表等进行评估。结果 和基线相比,培训后Conners 儿童行为问卷总分、品行问题及焦虑因子分下降,ADHD症状分级父母评量表各因子分（注意缺陷、多动、冲动）和对立违抗行为均有下降,照料者压力问卷总分下降,亲子关系自评量表总分、儿童自我意识量表总分以及躯体外貌属性、智力和学校行为因子分提高,以上差异均有统计学意义（P结论 ADHD 患儿家长培训能促进亲子间发展良好关系,减轻家长育儿压力。     

注意缺陷多动障碍共患焦虑和抑郁情况及其行为特点的研究

评估注意缺陷多动障碍（ADHD）患儿共患焦虑和抑郁情况,同时探讨共患疾病对其行为的影响特点。方法　2007-2009年在中南大学湘雅二医院儿童精神卫生专科门诊收集105例ADHD患儿,年龄8～14岁,均符合DSM-IV诊断标准,但不存在对立违抗障碍、品行障碍和抽动障碍。于某学校选取66名同年龄段,无ADHD、对立违抗障碍、品行障碍和抽动障碍的学生作对照组。对所有研究对象采用ADHD诊断量表、Achenbach儿童行为量表（CBCL） 、儿童焦虑性情绪障碍筛查表（SCARED）、儿童抑郁障碍自评量表（DSRSC）进行评定,对照组儿童经SCARED、DSRSC评定后选择正常的43名作为正常对照组用于分析。结果　105例ADHD中39例（37.1%）共患焦虑,66名对照组中13例（19.7%）共患焦虑,两者间差异有统计学意义（χ2 = 5.829,P = 0.016）。ADHD共患抑郁者33例31.4%）,对照组10例（15.2%）,差异有统计学意义（χ2 = 5.704,P = 0.017）。ADHD同时共患焦虑与抑郁者16例（15.2%）,对照组中未发现共患焦虑与抑郁者。ADHD患儿CBCL社会能力得分均低于对照组,行为问题得分除躯体主诉外均显著高于正常对照组,差异有统计学意义（分别P = 0.000～0.010、P = 0.000～0.007）。ADHD单纯共患焦虑组CBCL躯体主诉得分显著高于单纯ADHD组,差异有统计学意义（P < 0.05）;ADHD单纯共患抑郁组CBCL焦虑/抑郁得分显著高于单纯ADHD组,差异有统计学意义（P < 0.05）;ADHD同时共患焦虑与抑郁组CBCL退缩、躯体主诉、焦虑/抑郁、思维问题、注意问题和内化性问题均显著高于单纯ADHD组,差异有统计学意义（P < 0.05）。结论　ADHD患儿有较高的抑郁和焦虑共患情况,同时共患抑郁与焦虑的ADHD患儿存在更多的行为问题,需要更多的精神卫生服务。     

白血病患儿及其父母心理特点调查分析

目的探讨初诊及长期无病生存白血病患儿的情绪、自我意识特征及其父母的情绪特点。方法选用儿童焦虑性情绪障碍筛查表、儿童抑郁障碍自评量表和Piers-Harris儿童自我意识量表分别对40例初诊白血病、20例长期无病生存白血病和50例正常对照儿童进行评定,同时采用焦虑自评量表、抑郁自评量表对两组白血病儿童的父母进行心理测评。结果白血病患儿的焦虑和抑郁总分均显著高于正常对照组(P值分别为0.028和0.045);其中长期无病生存组患儿在躯体化/惊恐、广泛性焦虑和社交恐怖分量表评分明显高于正常对照组(P值分别为0.002、0.019、0.001和0.000)。初诊组患儿在社交恐怖分量表得分亦显著高于正常对照组(P=0.004),在学校恐怖分量表得分显著低于正常对照组(P=0.020)。总体白血病患儿的自我意识总分低于正常对照组(P=0.003),其中长期无病生存组在焦虑、合群、幸福与满足分量表得分显著低于正常对照组(P值分别为0.041、0.037和0.037),但自我意识总分与正常对照组相比差异无显著性(P=0.581);而初诊白血病组患儿在自我意识总分及行为、智力与学校情况、躯体外貌与属性、焦虑分量表得分显著低于正常对照组(P值分别为0.007、0.001、0.005、0.031和0.001)。白血病组父母焦虑和抑郁得分均显著高于我国常模组(P0.001),其中初诊白血病组父母的焦虑和抑郁症状检出率显著高于长期无病生存组(P值分别为0.015和0.032)。患儿父母的焦虑和抑郁得分有明显的相关性(r=0.95,P0.001),但与患儿的焦虑、抑郁及自我意识得分均无显著相关性(P0.05)。结论白血病患儿及其父母较正常对照组有更多的焦虑和抑郁情绪,白血病患儿的自我意识降低。因此,应重视对白血病患儿及其父母进行心理辅导及治疗。     

Association between maternal job burnout and adolescent depression: the chain mediating effect of maternal depression and parenting style北大核心CSCD

目的研究母亲职业倦怠与青少年抑郁的关系,以及母亲抑郁、教养方式在其中的中介作用。方法采用横断面研究设计,于2021年4—5月在上海市7所初中进行整群随机抽样,对7所初中2572名青少年及其母亲进行问卷调查。研究工具包括一般资料调查表、职业倦怠量表、流调中心抑郁量表、简式父母教养方式问卷及儿童抑郁量表。建立结构方程模型,使用Bootstrap法进行中介效应检验。结果青少年抑郁症状检出率为12.71%(327/2572)。母亲职业倦怠得分、母亲抑郁得分、消极教养方式得分与青少年抑郁得分呈显著正相关(P<0.05),而积极教养方式得分与青少年抑郁得分呈显著负相关(P<0.05)。母亲抑郁、教养方式在职业倦怠与青少年抑郁间起中介作用,包括母亲抑郁的独立中介、积极教养方式的独立中介及抑郁-消极/积极教养方式的链式中介。结论母亲的职业倦怠可通过抑郁、教养方式、抑郁-教养方式3条中介路径影响青少年抑郁,提示降低母亲职业倦怠、改善母亲的抑郁情绪、增加积极教养行为、减少消极教养行为,有助于减少青少年抑郁症状的发生。     

学龄前儿童听处理评估量表在注意缺陷多动障碍儿童中的应用研究

目的 利用学龄前儿童听处理评估量表(以下称“听处理评估量表”)探讨学龄前注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童的听处理(auditory processing,AP)特征。方法 41例ADHD及41例典型发育(typically developing,TD)儿童进行听处理评估量表、SNAP-Ⅳ评定量表及学龄前持续性注意力测试(Conners’Kiddie Continuous Performance Test,K-CPT)评估，分析比较两组儿童听处理评估量表得分差异及其与SNAP-Ⅳ评定量表和K-CPT结果的相关性。结果 ADHD组儿童听处理评估量表总分及除视觉注意维度外的其他维度得分高于TD组(P<0.05)。ADHD儿童中，SNAP-Ⅳ评定量表的注意缺陷维度得分与听处理评估量表总分(r_{s 30条}=0.531;r_{s 27条}=0.627)及其听觉解码(r_s=0.628)、听觉注意(r_s=0.492)、沟通交流(r     

Game‐based peripheral biofeedback for stress assessment in children

Background: Peripheral biofeedback is considered to be an efficient method for assessment and stress mitigation in children. The aim of the present study was to assess the levels of stress and stress mitigation in healthy school children (HSC), in children with cystic fibrosis (CF), general anxiety (GA) and attention‐deficit–hyperactivity disorder (ADHD). Methods: Each investigated group (HSC, CF, GA, ADHD) consisted of 30 school‐aged children from both sexes. Psychological characteristics were evaluated on Eysenck Personality Questionnaire (EPQ). The lie scale was used to determine participant honesty. Four biofeedback games using a pulls detector were applied for assessment of the stress levels as well as to evaluate ability to relax. Results: EPQ found more psychopathological traits (P < 0.001) and less extroversion (P < 0.001) in children with GA and ADHD. In addition, high neurotic tendencies were found in children with CF (P < 0.01) and GA (P < 0.01). Unexpectedly, the lie scale was lower in ADHD children (P < 0.01) than in all other groups (HSC, CF, GA). The Magic blocks score was significantly different in relaxation levels between control and CF children (P < 0.05). Speed in the game Canal was significantly different in relaxation levels between healthy controls and all other groups, but no changes in pulls, as a relaxation measure, were found during the game. The CF group had much more commissions stemming from impulsivity (t= 5.71, P < 0.01), while the GA and ADHD children had more inattention omissions (P < 0.05). Strong negative correlation between age and pulls (r= 0.49, P= 0.003) and strong negative correlation between age and omissions (r=?0.86, P= 0.029) were found among all groups analyzed. Conclusions: The ability to learn stress mediation is correlated with age. All three groups of children had significantly lower relaxation levels when compared to healthy controls. Relaxation was more difficult for children with GA or ADHD, and easier for children with CF.     

The Inter-Relationships of Extremely Low Birth Weight,Asthma, and Behavior: A Study of Common Cause,Mediation, and Moderation

BackgroundExtremely low birth weight (ELBW; <1000 g) infants are at risk for both asthma and problems like inattention, hyperactivity, anxiety, and depression. Asthma predicts behavioral and emotional problems in term-born children. The nature of these associations is poorly understood. We tested 3 models of association: independent risk, mediation, and effect modification to explore interplay among birth weight, asthma, and behavioral and emotional problems.MethodsWe used data from a prospective cohort of ELBW infants born 1992 to 1995. Exposure was ELBW; primary outcomes were parent-reported diagnosis of asthma and symptoms of inattention, hyperactivity, anxiety, and depression at age 8 years. Covariates included child sex and maternal socioeconomic status.ResultsThere were 139 ELBW and 101 normal BW (>2500 g) children followed to 8 years. ELBW children were more likely to have asthma (35.7% vs 14.4%, P < .05). Inattention, hyperactivity, depression, and anxiety scores were higher among ELBW children and children with asthma. ELBW was a common cause of asthma and anxiety. There was no evidence of mediation or effect modification by asthma on the effect of ELBW on behavior and emotion symptoms.ConclusionAsthma does not underlie or amplify the effect of ELBW on behavioral and emotional problems at school age, suggesting that increased risk for respiratory morbidity and neurodevelopment represent largely independent consequences of developmental vulnerability related to ELBW. Noting the impact of chronic illnesses on neurodevelopment in other populations, data focused on symptom trajectories over time in a larger cohort may be necessary to shed further light onto this question.     

儿童注意缺陷多动障碍共患病及功能损害研究

目的 评估注意缺陷多动障碍(ADHD)患儿共患病及功能损害发生情况,并探讨其与核心症状(注意缺陷、多动冲动)的相关性。方法 疑诊为ADHD 的319例儿童作为研究对象,由父母完成Vanderbilt父母评定量表(VADPRS),根据美国精神病学会制定的《精神障碍诊断和统计手册》第四版(DSM-IV)进行诊断及分型,根据VADPRS进行共患病筛查及功能损害评估。同时对各型ADHD患儿共患病和功能损害情况进行比较,对其与核心症状的关系进行相关性分析。结果 319例儿童中,196例诊断为ADHD,其中注意缺陷型(ADHD-I)84例,多动冲动型(ADHD-HI)35例,混合型(ADHD-C)77例。123例不满足ADHD诊断标准。ADHD儿童共患病(对立违抗性障碍、品行障碍、情绪障碍)发生率显著高于非ADHD儿童(63.8% vs 37.4%, P<0.05)。ADHD-C组对立违抗和品行障碍发生率高于ADHD-I组(P<0.05)。对立违抗、品行障碍及情绪障碍的阳性条目数与两个核心症状群阳性条目数有弱相关性(P<0.01)。ADHD组总功能损害发生率显著高于非ADHD组(89.8% vs 74.8%, P<0.05)。ADHD-C组功能损害发生率显著高于ADHD-I组和ADHD-HI组(P<0.05)。注意缺陷阳性症状条目数与学习问题、同胞关系损害及组织活动问题有弱相关性(P<0.01),多动冲动阳性症状条目数仅与同胞关系损害有弱相关性(P<0.01)。结论 ADHD组儿童共患病及功能损害发生率高,以ADHD-C组最显著。ADHD核心症状严重程度可以影响共患病及功能损害的发生。未达到ADHD诊断标准的疑诊儿童也有较高的其他精神障碍和功能损害发生率,临床上也要重视对此类儿童的干预。     

Iron deficiency in Indian children with attention deficit hyperactivity disorder

A case control study was conducted at the Child Development and Early Intervention Clinic to determine the body iron status of children with ADHD, and study the correlation between the body iron status and ADHD symptoms. Serum ferritin was measured in newly diagnosed cases with ADHD and compared with that of controls. Correlation was studied between serum ferritin levels and the severity of ADHD symptoms as determined by Conners’ Rating Scale. Serum ferritin was found to be significantly lower in children with ADHD (6.04 ± 3.85 ng/mL) as compared to controls (48.96 ± 41.64 ng/mL, P value<0.001). There was a significant negative correlation between serum ferritin levels and oppositional subscore on Conners’ Rating Scale.     

Impact of COVID-19 on lifestyle habits and mental health symptoms in children with attention-deficit/hyperactivity disorder in Canada

ObjectivesThe COVID-19 pandemic created an environment of restricted access to health and recreation services. Lifestyle habits including sleep, eating, exercise, and screen use were modified, potentially exacerbating adverse mental health outcomes. This study investigates the impact of COVID-19 on lifestyle habits and mental health symptoms in paediatric attention-deficit/hyperactivity disorder (ADHD) in Canada.MethodsAn online survey was distributed across Canada to caregivers of children with ADHD (children aged 5 to 18 years) assessing depression (PHQ-9), anxiety (GAD-7), ADHD (SNAP-IV), and lifestyle behaviours. Data were analyzed by gender (male/female) and age category (5 to 8, 9 to 12, and 13 to 18 years). Spearman’s correlations between lifestyle habits and mental health outcomes were conducted.ResultsA total of 587 surveys were completed. Mean child age was 10.14 years (SD 3.06), including 166 females (28.3%). The PHQ-9 and GAD-7 indicated that 17.4% and 14.1% of children met criteria for moderately severe to severe depression and anxiety symptoms respectively. Children met SNAP-IV cut-off scores for inattention (73.7%), hyperactivity/impulsivity (66.8%), and oppositional defiant disorder (38.6%) behaviours. Caregivers reported changes in sleep (77.5%), eating (58.9%), exercise (83.7%), and screen use (92.9%) in their ADHD child, greatly impacting youth. Sleeping fewer hours/night, eating more processed foods, and watching TV/playing videogames >3.5 hours/day correlated with greater depression, anxiety and ADHD symptoms, and exercising <1 hour/day further correlated with depression symptoms (P<0.01).ConclusionsThe COVID-19 pandemic has resulted in less healthy lifestyle habits and increased mental health symptoms in Canadian children with ADHD. Longitudinal studies to better understand the relationship between these factors are recommended.