注意缺陷多动障碍儿童的智力结构及社会适应行为特点

背景注意缺陷多动障碍( attention deficit hyperactivity disorder,ADHD)患儿注意力不集中常给学习带来困难,影响学习成绩.近年来关于 ADHD儿童的智能发育及社会适应方面的研究不少,但结论不一致. 目的探讨 ADHD儿童智力结构及社会适应行为特点. 设计以诊断为依据的病例对照研究. 方法选取 ADHD 患儿 48例,健康儿童 48例,利用韦氏学龄智力量表和社会适应行为评定量表评定其智力和社会适应能力,比较其智力结构和适应行为特点. 结果智力方面 ADHD患儿言语智商 (101.23± 7.45)高于其操作智商 (89.72± 8.00),差异有显著性意义 (t=2.241,P< 0.05), ADHD患儿言语、操作及总智商 (101.23± 7.45 ,89.72± 8.00, 94.12± 10.28)均低于对照组相应智商 (105.46± 8.70, 102.85± 9.36, 104.20± 8.57),差异有显著性意义 (t=2.360,2.547,2.012, P< 0.05);不分心因子和获得因子得分 (16.10± 3.86, 25.47± 5.01)低于对照组 (20.00± 3.94, 29.33± 4.46),差异有显著性意义 (t=2.764, 3.223,P< 0.01),社会适应方面 ADHD患儿独立功能因子得分和认知因子得分 (61.20± 6.14, 56.80± 5.86)高于对照组( 51.66± 5.47 ,48.24± 4.98),差异有显著性意义 (t=2.560, 2.589,P< 0.05 ),而社会 /自制因子得分 (40.32± 6.22)低于对照组 (57.86± 6.03) 差异有显著性意义 (t= 2.412, P< 0.05). 结论 ADHD患儿智力结构和社会适应能力存在缺陷,积极防治对于保证其智力发育和社会适应能力的提高具有重要意义.     

Inhibition and Mental Effort in Attention Deficit Hyperactivity Disorder

The efficiency of cognitive inhibition was contrasted in children diagnosed with ADHD and a control group of age- and IQ-matched average children. Two tasks were used to measure inhibitory ability: the negative-prime Stroop task and a directed-forgetting memory task. Based on contemporary theoretical perspectives that postulate deficits in inhibitory function in the ADHD population, it was predicted that ADHD children would be significantly less efficient inhibitors than the average children. Contrary to predictions, however, ADHD children showed no deficits in inhibitory abilities compared to controls. Average children were faster on the second administration of the Stroop task, whereas ADHD children were slower. These results were interpreted within the framework of the inhibition models. It was proposed that differences in inhibitory abilities, such as the ones tapped here, may appear earlier than age 8, and that the engaging aspects of tasks may have optimized the ADHD children's performance. The slower performance of the ADHD group on the second administration of the Stroop task is consistent with the hypothesis that although ADHD children can inhibit, they find it more effortful to do so than do average children.     

Comparison of Parenting Stress in Different Developmental Disabilities

Research has shown that parents of children with special health care needs experience more parenting stress than parents of typically developing children, but the relation between the type of disability and parenting stress is far from clear (Stein 1988; Tew and Lawrence 1975; Breslau et al. 1982; Miller et al. 1992). To explore the relation between the type of disability and parenting stress, parenting stress data on the Parenting Stress Index (PSI) (Abidin 1995) and demographic information were collected from convenience samples of parents of four cohorts of children: children with ADHD, children with developmental disabilities, children with HIV infection and children with asthma, and typically developing children. Parents of children with attention deficit hyperactivity disorder (ADHD) and parents of children with developmental disabilities (DD) reported higher total stress than parents of HIV-infected, asthmatic, and typically developing children. Ethnicity did not explain any of the group differences, but caregiver’s language, education, employment status, and overall life stresses explained some of the group differences in parent-related domains. Level of stress in parents of children with special needs is determined by overall nature of the disorder, with the parents of children with ADHD and developmental disorders reporting higher levels of parenting stress than children with HIV infection, asthma, and healthy controls.     

儿童注意缺陷多动障碍脑功能及功能连接研究

目的使用静息态功能磁共振成像技术研究注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童的大脑局域自发功能活动及功能连接。材料与方法对10例ADHD患儿及10例正常对照组儿童进行全脑扫描,获取静息态功能图像。计算得到每个被试的低频振幅(amplitude of low-frequence fluctuation,ALFF)参数图,进行基于体素的组间比较。选取ALFF与对照组有显著差异的脑区做种子点,得到该区域与其他脑区之间的功能连接强度参数图,采用相同的方法比较两组被试之间的差别。结果与正常对照组相比,ADHD患儿在前扣带回、前额叶、尾状核等脑区存在显著的ALFF升高,提示自发功能活动更加活跃。与对照组相比,以前扣带为种子点,ADHD儿童在双侧丘脑、岛叶及后扣带区域功能连接显著升高;以右侧前额叶的脑区为种子点,ADHD的右侧中央前回和颞上回的功能连接下降;以尾状核为种子点,ADHD在双侧的额中回功能连接下降。结论 ADHD儿童局域脑区自发功能活动及其功能连接异常,揭示ADHD症状与认知注意网络的发育延迟或缺损有关。     

Prediction of school performance using the Miller Assessment for Preschoolers (MAP): a validity study.

OBJECTIVE: The purpose of this study was to examine the ability of the Miller Assessment for Preschoolers (MAP) to predict academic performance of Israeli preschoolers after a period of 5 to 7 years. METHOD: Thirty children who were classified according to the MAP as preschoolers at risk (n= 15) and not at risk (n= 15) for pre-academic problems were tracked after 5 to 7 years. Follow-up evaluations were done on motor, visual-motor integrative, and cognitive performance components; reading and handwriting academic performance areas; and a variety of measures taken to establish overall school functional status. RESULTS: Results indicate that children classified by the MAP as preschoolers at risk performed significantly worse 5 to 7 years later on visual-motor, cognitive, and reading and handwriting tests than those preschoolers classified not at risk and demonstrated reduced overall school functional status. CONCLUSION: The findings indicate that the MAP can predict academic performance even over a 5-year to 7-year interval. Furthermore, by linking academic performance data to performance components of children in different cultures, our investigation contributes to the overall understanding of children's functioning.     

高铅血症与儿童注意缺陷多动障碍发病率的研究

目的探讨高铅血症儿童中注意缺陷多动障碍（ADHD）的发病率。方法收集1047例高铅血症（血铅≥100μg/L）儿童,按性别及年龄分别分组。血铅使用原子吸收光谱仪测定。结果1047例高铅血症儿童中共确诊ADHD179例,总发病率为17．09％。男童中ADHD的发病率为18．90％,高于女童ADHD的发病率10．36％,（P〈0．005）。226例〈6岁儿童ADHD发病率为3．98％,821例6～15岁儿童ADHD发病率为20．71％,2组发病率比较差异有统计学意义（P〈0．005）。6～15岁儿童组中确诊ADHD170例,按性别分组后661例男童中ADHD的发病率为22．39％,高于160例女童中ADHD的发病率13．75％,（P〈0．025）。结论高铅血症中〈6岁儿童ADHD发病率显著低于6～15岁儿童。6～15岁男童的ADHD发病率显著高于女童。     

Diet and physical exercises for preschoolers with ADHD and their mothers: An intervention study

BackgroundAttention deficit hyperactivity disorder (ADHD) is a serious public health problem. Diet-focused approaches and physical exercise can be used to complement other ADHD management techniques.ObjectiveTo determine the prevalence of ADHD symptoms among preschoolers in nursery schools and to evaluate the educational interventions toward nutrition and physical exercise in mothers and their preschoolers with ADHD symptoms.Research methodologyA two-phase sampling method was employed. First, a cross-sectional survey was conducted to determine the prevalence of ADHD symptoms in four nursery schools (400 preschoolers aged between 3 and 6 years). Second, an intervention study (a quasi-experimental research design with one group completing the pre-test and the post-test) was performed on 36 preschoolers having ADHD symptoms and their mothers by using the educational intervention for mothers and photos and games about nutrition and physical exercise for the preschoolers with ADHD; mothers of four children out of the 40 refused to participate in the study. Data were analyzed using SPSS version 20. The paired t-test was used to determine significant differences between the groups. Differences were considered significant at P < 0.05.ResultsOf the 400 preschoolers, 10% had high ADHD symptoms. The mean score of mothers’ knowledge of nutrition and physical exercise improved after the implementation of the program (p = 0.01). In addition, preschoolers with ADHD enjoyed the session with photos and games (p = 0.01).Conclusions and ImplicationsEducational intervention significantly improved the knowledge of the mothers. Moreover, preschoolers with ADHD symptoms enjoyed the session with photos and games. This intervention appears to be feasible and promising for further investigation of its effects.     

Self-perception in children with attention deficit/hyperactivity disorder

The purpose of this study was to compare self-perceptions of children diagnosed with attention deficit/hyperactivity disorder (ADHD) with those of children not diagnosed with ADHD. Seventy-seven children aged 8-12 years composed the two groups-38 participants with ADHD and 39 control participants without ADHD. The children completed the Self-Perception Profile for Children Questionnaire designed to measure self-perceptions in school-aged children. t Tests compared differences in mean scores between the groups. The ADHD group had a significantly lower overall score and a lower score on the behavioral conduct subscale compared with children without ADHD. Findings suggest a difference in the way school-aged children with ADHD perceive themselves as compared with their peers. The cumulative effect of years of low self-esteem and negative self-perception may have significant life consequences. Attention should be focused on fostering self-esteem and positive self-perception in children with ADHD through support groups and behavioral training.     

Emotion Regulation in Children with Emotional Problems

The emotion regulation (ER)-specificity hypothesis assumes that a specific psychological problem is characterized by a specific maladaptive ER strategy. This hypothesis will be investigated for six child-DSM symptom clusters (Study 1) and for depressive symptoms (Study 2). We also investigated whether certain emotion regulation strategies can be detected through different forms of symptom clusters. Study 1 includes 432 school aged non-referred youngsters (60 % girls; age range between 8 and 18 years) and Study 2 includes 128 school aged non-referred youngsters (55 % girls; age range between 10 and 14 years). A self-report questionnaire, FEEL-KJ investigates a wide range of adaptive and maladaptive ER strategies. DSM symptom clusters (affective, anxiety, somatic, conduct, oppositional and ADHD problems) were measured by parent report on the Child Behaviour Checklist; depressive symptoms were measured with the Child Depression Inventory. Youngsters with emotional problems have specifically less adaptive ER strategies. The relation with maladaptive ER strategies can only be detected with self-reported depressive symptoms. ER strategies problem-oriented action and acceptance are transdiagnostically related to both internalizing and externalizing problems. For affective, somatic, conduct and ADHD problems the ER-specificity hypothesis is confirmed. Investigating ER strategies could be of clinical relevance specifically in children with affective, somatic, conduct and ADHD problems. Next, training deficits in the ER strategies Problem-oriented action and Acceptance can be considered as important in the treatment of all children with emotional problems.     

Perception of Nonverbal Emotion Cues by Children with Nonverbal Learning Disabilities

The purpose of this study was to document deficits in the perception of nonverbal emotion cues that have been implicated as a cause of social maladjustment in children with nonverbal learning disabilities (NLD). Thirty-three children between the ages of 9 and 14 identified as having NLD, verbal learning disabilities (VLD), or as nonlearning disabled psychiatric controls were administered the Diagnostic Analysis of Nonverbal Accuracy and Personality Inventory for Children – Revised (PIC-R) to measure social perception and social adjustment, respectively. The NLD group was significantly less accurate than were the VLD and control groups in interpreting adult facial expressions and gestures, and significantly less accurate than was control group in interpreting subtle (i.e., low intensity) adult facial expressions. There was a nonsignificant trend toward more social skill deficits demonstrated on the PIC-R by the NLD group than the other study groups. Children with NLD were twice as likely as children with VLD to be diagnosed with an internalizing disorder. There were also consistent and compelling trends in the predicted direction with the NLD group showing the most impairment on measures of nonverbal perception.     

0～3岁儿童发育迟缓监测研究

目的探索0～3岁儿童发育迟缓监测预防的有效性及数据直报的可行性。方法采用整群抽样的方法,在北京市五个区县22个社区对20907名0～3岁儿童进行为期1年的发育监测,采用问卷、信息报表方式收集相关数据,并与非项目社区监测结果进行比较分析。结果社区儿童发育迟缓筛查率62.18%,0岁组筛查率明显高于1岁组、2岁组,三个年龄组筛查率明显高于非项目社区筛查率。筛查阳性儿童268人,转诊253名儿童,转诊率为94.4%;诊断发育迟缓儿童97名,发育迟缓现患率为7.46‰;43.28%的评估儿童接受干预与康复训练。结论 0～3岁儿童发育迟缓监测方法可以提供监测的有效性,并在数据直报方面具有可行性和有效性。     

High Prevalence of Developmental Disabilities in Children Admitted to a General Pediatric Inpatient Unit

Objective: Evaluate a) the prevalence of developmental disabilities (DD) in children admitted to a general pediatrics inpatient unit, and b) the number of children admitted to the unit with previously undiagnosed developmental disability. Methods: Prevalence was evaluated through retrospective record review. Subjects: One hundred ninety children older than five months of age admitted to a general pediatric unit. Results: Of 190 children admitted, 155 (81.6%) had adequate developmental screening documented in the record. Forty-nine (25.7% of total, 31.6% of screened) had a developmental disability, 22 (12.1% of total, 14.8% of screened) had a previously unrecognized disability. Sample prevalence of DD was: cerebral palsy (6.8%), developmental delay or mental retardation (8.4%), language delay (4.6%), learning disability (8.2%), and hearing loss (1.5%). New diagnoses included: three children with probable mental retardation (MR), nine with learning disability (may include mild MR), seven with language delay, three with abnormal motor skills (fine and/or gross motor), one each of: neurofibromatosis type I, hearing loss, cerebral palsy, dysphagia. Some children had more than one new diagnosis. Conclusion: The prevalence of disabilities in a general pediatrics inpatient unit is much higher than the prevalence in the community. Because almost half of the disabilities were previously unrecognized, acute hospitalization is an excellent opportunity to conduct developmental screening.     

Optimized voxel-based morphometry in children with developmental dyscalculia

Developmental dyscalculia (DD) is a specific learning disability affecting the normal acquisition of arithmetic skills. Current studies estimate that 3-6% of the school population is affected by DD. Genetic, neurobiological, and epidemiologic evidence indicates that dyscalculia is a brain-based disorder. Imaging studies suggest the involvement of parietal and prefrontal cortices in arithmetic tasks. The aim of the present study was to analyze if children with DD show structural differences in parietal, frontal, and cingulate areas compared to typically achieving children. Magnetic resonance imaging was obtained from 12 children with DD aged 9.3+/-0.2 years and 12 age-matched control children without any learning disabilities on a 1.5 T whole-body scanner. Voxel-based morphometry analysis with an optimization of spatial segmentation and normalization procedures was applied to compare the two groups in order to find differences in cerebral gray and white matter. Compared to controls, children with DD show significantly reduced gray matter volume in the right intraparietal sulcus (IPS), the anterior cingulum, the left inferior frontal gyrus, and the bilateral middle frontal gyri. White matter comparison demonstrates clusters with significantly less volume in the left frontal lobe and in the right parahippocampal gyrus in dyscalculic children. The decreased gray and white matter volumes in the frontoparietal network might be the neurological substrate of impaired arithmetic processing skills. The white matter volume decrease in parahippocampal areas may have influence on fact retrieval and spatial memory processing.     

Effects of Reward and Response Cost on the Performance and Motivation of Children with ADHD

This study examined the effects of reward and response cost on the performance and motivation of 40 children with ADHD and 40 controls. Participants completed an arithmetic task under one of three (reward, response cost, and no contingency) conditions. Dependent variables included pretest attributional measures, direct performance measures, self-rated performance and motivation, and a postcontingency free-choice behavioral motivation measure. Relative to controls, children with ADHD reported a less adaptive attributional style and differed in their attributions for predicted good and poor performance. For children with ADHD, response cost improved accuracy on the arithmetic task relative to reward and resulted in higher motivation in the second half of the behavioral motivation measure; however, reward had a relatively more salutory effect on self-rated motivation. No negative effects of either reward or response cost on perceived performance or willingness to do the task again, or the behavioral motivation measure, were found for either group.     

Conduct behaviors and oppositional defiant behaviors in children and adolescents with ADHD

There is controversy about the association among attention deficit hyperactivity disorder (ADHD), conduct disorder behaviors, and oppositional defiant behaviors. This study examines whether different subcategories of conduct behaviors co-occur in children with ADHD, and investigates the association of conduct behaviors with ADHD symptoms and oppositional defiant behavior, considering the covariant factors of parental age and educational level. A total of 441 children and adolescents with ADHD participated in this study – 342 (77.6%) boys and 99 girls (22.4%). Their mean age was 9.1 (standard deviation = 2.2) years. They came from families with 1 to 8 children. There were statistically significant correlations among different subcategories of conduct disorder (p < 0.001 for all the correlations). Oppositional behavior scores were associated with all 4 subcategories of conduct behaviors. The severity of hyperactivity/impulsivity was associated with the subcategory of “destruction of property.” The inattentiveness score was associated with “aggression to people and animals.” The current results do not suggest that conduct behaviors exclude oppositional defiant behaviors. The subcategories of conduct behaviors occur in a cluster rather than as a solitary behavior. Larger family size and lower educational level of the father increase the risk of aggression to people and animals in children with ADHD.     

A Two Time Point Study of Imitative Abilities in Children with Autism Spectrum Disorders

Background Researchers have used various paradigms to explore the universality and specificity of imitation deficits in children with autism spectrum disorders (ASDs). However, some issues still need to be investigated, especially for children with ASDs under the age of 4. Method Two studies were conducted to examine the imitative abilities of children with autism spectrum disorders. Study 1 examined immediate and deferred imitation abilities in 18 children with ASDs, 18 children with developmental delay (DD), and 19 typically developing children (mean ages of all groups were below 4 years). Four tasks were used to evaluate immediate imitation abilities: meaningful actions on objects, non‐meaningful actions on objects, manual movements, and oral‐facial movements. Eighteen months after study 1 was completed, study 2 examined advanced imitative abilities in 11 children with ASDs and 11 children with DD from study 1. Results The results of study 1 indicated that, compared to the two control groups, children with ASDs experienced significant difficulty in imitating non‐meaningful actions only. The findings of study 2 suggested that children with ASDs were still significantly impaired on the imitation of single non‐meaningful actions compared to children with DD. Conclusions The relationships between specific imitation deficits, executive functioning, and shared intentionality in children with ASDs are further discussed.     

A DSM-IV Axis I Comorbidity Study of Males (n = 120) with Paraphilias and Paraphilia-Related Disorders

One hundred and twenty consecutively evaluated outpatient males with paraphilias (PAs; n = 88, including 60 sex offenders) and paraphilia-related disorders (PRDs; n = 32) were systematically assessed for certain developmental variables and DSM-IV-defined Axis I comorbidity. In comparison with the PRDs, the PA group was statistically significantly more likely to self-report a higher incidence of (but not sexual) abuse, fewer years of completed education, a higher prevalence of school-associated learning and behavioral problems, more psychiatric/substance abuse hospitalizations, and increased employment-related disability as well as more lifetime contact with the criminal justice system. In both groups, the most prevalent Axis I disorders were mood disorders (71.6%), especially early onset dysthymic disorder (55%) and major depression (39%). Anxiety disorders (38.3%), especially social phobia (21.6%), and psychoactive substance abuse (40.8%), especially alcohol abuse (30%), were reported as well. Cocaine abuse was statistically significantly associated with PA males (p = .03). There was a statistically significant correlation between the lifetime prevalence of Axis I nonsexual diagnoses and hypersexual diagnoses (PAs and PRDs). The prevalence of retrospectively diagnosed attention deficit hyperactivity disorder (ADHD) was 35.8%, the third most prevalent Axis I disorder. ADHD (p = .01), especially ADHD-combined subtype (p = .009), was statistically significantly associated with PA status. ADHD was statistically significantly associated with conduct disorder, and both of these Axis I disorders were associated with the propensity for multiple PAs and a higher likelihood of incarceration. When the diagnosis of ADHD was controlled, the differences reported above between PAs and PRDs either became statistically nonsignificant or remained as only statistical trends. Thus, ADHD and its associated developmental sequellae and Axis I comorbidities was the single most common nonsexual Axis I diagnosis that statistically significantly distinguished males with socially deviant sexual arousal (PAs) from a nonparaphilic hypersexual comparison group (PRDs). Sex offender paraphiliacs were more likely to be diagnosed with conduct disorder, alcohol abuse, cocaine abuse, and generalized anxiety disorder. The prevalence of any ADHD in the sex offender paraphiliacs was 43.3%, and nearly 25% of offenders were diagnosed with ADHD-combined subtype.     

The Neuropsychological and Neurobehavioral Consequences of ADHD Comorbid with LD and Otitis Media

The purpose of this study was to identify a possible subtype of attention deficit hyperactivity disorder (ADHD) comorbid with learning disabilities (LD) and otitis media (OM). Data collected from children with ADHD, LD and otitis media included: Wechsler Intelligence Scale for Children—III, Intermediate Visual and Auditory continuous performance test, neurobehavioral rating, neuropsychological testing, neurophysiological function, and school grades. Findings included deficits in: auditory processing, interpersonal relations, increased social stress, external locus of control, and academic impairment. Parents rated ADHD as mild despite high theta to beta ratios along with neuropsychological dysfunction. Increased severity of ADHD and LD was associated with OM. There may be a unique ADHD subtype with phonological processing deficits. Implications for auditory vs. visual information transmission are discussed. The data collected was obtained from the author’s dissertation completed at The Union Institute & University.     

Evaluation and treatment of ADHD

Symptoms of attention-deficit/hyperactivity disorder (ADHD) are present in as many as 9 percent of school-age children. ADHD-specific questionnaires can help determine whether children meet diagnostic criteria for the disorder. The recommended evaluation also includes documenting the type and severity of ADHD symptoms, verifying the presence of normal vision and hearing, screening for comorbid psychologic conditions, reviewing the child's developmental history and school performance, and applying objective measures of cognitive function. The stimulants methylphenidate and dextroamphetamine remain the pharmacologic agents of first choice for the management of ADHD. These agents are equally effective in improving the core symptoms of the disorder, but individual children may respond better to one stimulant medication than to another. Achievement of maximal benefit may require titration of the initial dosage and dosing before breakfast, before lunch and in the afternoon. The family physician should tailor the treatment plan to meet the unique needs of the child and family. Psychosocial, behavioral and educational strategies that enhance specific behaviors may improve educational and social functioning in the child with ADHD.     

Praxis skills in young children with Down syndrome, other developmental disabilities, and typically developing children.

This study explored whether young children with Down syndrome show praxis deficits that impact activities of daily living, and whether these deficits are specific to Down syndrome. We compared the performance of young children with Down syndrome, a mental age-matched group of children with developmental disabilities of mixed or unknown etiologies, and a group of typically developing infants and toddlers on praxis tasks and overall adaptive behavior (Vineland Adaptive Behavior Scales). Children with Down syndrome showed poorer overall motor functioning than the developmental disabilities comparison group as measured by the Vineland Adaptive Behavior Scales, F(2, 47) = 5.24, p < .01 (using one-way analysis of variance [ANOVA]). A one-way multivariate analysis of variance also showed that children with Down syndrome performed significantly worse overall than the developmental disabilities comparison group on a battery of praxis tasks, F(7, 18) = 2.95, p < .05, and a series of object retrieval tasks, F(7, 18) = 2.95, p < .05, suggesting a deficit in praxis that is specific to Down syndrome. Children with Down syndrome elicited significantly more help than both comparison groups during object retrieval trials, F(2, 48) = 4.94, p < .01 (using one-way ANOVA). When chronological age was partialled out, a strong relationship was observed between praxis and adaptive functioning in Down syndrome, r(8) = .69, p < .05. These findings suggest that young children with Down syndrome may need targeted interventions that focus on both praxis skills and motivational orientation.