感觉统合训练联合盐酸哌甲酯治疗儿童注意缺陷多动障碍临床疗效分析

目的探讨感觉统合训练（SIT）联合盐酸哌甲酯治疗儿童注意缺陷多动障碍（ADHD）的临床疗效。方法对2009年1月-2013年3月就诊的96例ADHD患儿的临床资料行回顾性分析,并按随机数字表分组,研究组（n=48）联合SIT及盐酸哌甲酯治疗,对照组（n=48）单用盐酸哌甲酯治疗,比较两组儿童感觉统合能力发展评定量表、视听连续整合测试（IVA-CPT）、Conner行为评定量表、韦氏儿童智力量表（C-WISC）评分及不良反应情况。结果两组ADHD患儿治疗后感觉统合评定量表各项目评分,IVA-CPT中综合反应控制商数及综合注意力商数,C-WISC中操作量表智商、言语量表智商、全量表智商及注意/不分心因子评分均较之治疗前有明显提高;Conner行为评定量表中学习、品行、身心障碍、冲动、多动指数、焦虑因子评分均有下降,治疗前后比较差异有统计学意义（P〈0.05）。研究组加行SIT后感觉统合评定量表、IVA-CPT、Conner行为评定量表、C-WISC各项评分改善均较对照组明显,且不良反应明显少,两组比较差异有统计学意义（P〈0.05）。结论对于ADHD患儿,SIT联合盐酸哌甲酯治疗,有效且安全,值得推广。     

盐酸托莫西汀与盐酸哌甲酯治疗儿童注意缺陷多动障碍的对比研究

目的比较盐酸托莫西汀(ATX)与盐酸哌甲酯(MPH)治疗儿童注意缺陷多动障碍(ADHD)的临床疗效及安全性。方法 78例ADHD患儿随机分为ATX组(n=39)和MPH组(n=39),分别口服ATX及MPH治疗8周后,依照注意缺陷多动障碍筛查(SNAP-Ⅳ)量表和Conners儿童行为问卷父母用量表(PSQ)分别评估2组临床疗效及ADHD症状的严重程度,采用副反应量表(TESS)比较2组安全性。结果治疗后,2组SNAP-Ⅳ量表中各因子评分、总评分及PSQ中各因子评分均显著降低(P0.01),而2组间SNAP-Ⅳ量表中各因子评分△值均无显著差异(P0.05),PSQ中ATX组焦虑因子及冲动因子△值显著大于MPH组(P0.05),其他因子△值、2组有效率及完全缓解率无显著差异(P0.05)。MHP组不良反应发生率41.03%(16/39)显著高于ATX组20.51%(8/39)(P0.05)。结论 ATX与MPH治疗ADHD的疗效相当,但ATX不良反应少,更具安全性。     

阿托莫西汀与哌甲酯治疗儿童注意缺陷多动障碍疗效与安全性的Meta分析

目的系统评价阿托莫西汀与哌甲酯治疗儿童注意缺陷多动障碍的临床疗效。方法计算机检索Cochrane图书馆（2008年第2期）、PubMed（1970～2008）、EMbase（1971～2008）、Medscape（1990～2008）、CBM（1978～2008）、NRR（1950～2008）,手工检索已发表与未发表的资料,收集有关阿托莫西汀与哌甲酯比较治疗儿童注意缺陷多动障碍的随机对照试验（RCT）。由两名评价者独立选择试验、提取资料和评估方法学质量,采用Cochrane协作网RevMan4．2．8软件进行统计分析。结果最终纳入3个RCT,共1597例患者。Meta分析结果显示,两组ADHD—RS量表总分数、多动／冲动分量表分值及CGI—ADHD—S量表分值差异均无统计学意义,其RR（95％CI）分别为-1．09（-5．35,3．16）,-0．27（-2．85,2．31）和-0．06（-0．49,0．38）。而两组ADHD—RS注意缺陷分量表分值差异有统计学意义[RR-1．79,95％CI（-2．22,-1．35）],表明哌甲酯在注意缺陷评定分量表上优于阿托莫西汀。两组副反应也无差异。结论阿托莫西汀与哌甲酯比较,尚不能确定何者疗效更明显。由于纳入RCT太少,且测量指标为终点替代指标,故其长期疗效、对不同亚组患者作用的差别及其安全性等尚不明确,仍需开展更多高质量的RCT进一步验证。     

注意缺陷多动障碍患儿盐酸哌甲酯治疗依从性影响因素的质性研究

目的:探讨影响儿童注意缺陷多动障碍盐酸哌甲酯治疗依从性的因素.方法:应用质性研究中的现象学研究方法,对2019年2月—2019年6月在医院进行盐酸哌甲酯治疗的17例依从性差的注意缺陷多动障碍患儿家长进行半结构式访谈,应用Colaizzi 7步分析法分析资料.结果:影响注意缺陷多动障碍患儿盐酸哌甲酯治疗依从性的因素归纳为3个主题:家长疾病应对能力不足、患儿主观能动性差、社会支持系统缺乏.结论:儿童注意缺陷多动障碍患儿哌甲酯治疗依从性的影响因素来自其自身及社会诸多方面,在患儿治疗过程中医护人员应采取针对性的个性化护理干预,以提高患儿治疗依从性.     

IVA-CPT法对哌甲酯缓释片治疗儿童注意缺陷多动障碍的疗效评估

目的通过对56例患注意缺陷多动障碍(ADHD)儿童进行哌甲酯缓释片治疗前后整合视听连续执行测试(IVA-CPT)数值的对比,探讨其治疗效果及疗效评估。方法所有入选患儿均在治疗前给予IVA-CPT测试,然后给予盐酸哌甲酯缓释片18 mg口服,1次/d,2⁴周随访一次,用药34周随访一次,用药3⁵个月再进行IVA-CPT测试。结果反应控制商数(视听)和注意商数(视听)治疗前后经配对t检验,差异均有统计学意义(P<0.01)。结论哌甲酯缓释片对ADHD患儿注意缺陷、控制力差,多动冲动等核心症状的改善有明显效果,而IVA-CPT检测对ADHD患儿的疗效具有直观、综合的评估作用。     

儿童注意缺陷多动障碍对学习的影响

目的探讨注意缺陷多动障碍对儿童学习的影响及其干预方法。方法采用儿童注意缺陷多动障碍家长问卷及儿童注意缺陷多动障碍教师问卷对75名注意缺陷多动障碍儿童及其父母及老师进行问卷调查。结果对所有家长及教师的调查表明注意缺陷多动障碍儿童有明显的学习障碍，学习成绩多居于中等水平。结论对注意缺陷多动障碍儿童的教育方法应采取因材施教、循序渐进和切合实际的方法进行。     

注意缺陷多动障碍儿童不同亚型的平衡功能研究

目的 对注意缺陷多动障碍(attention deficit hyperactivity disorder，ADHD)患儿的平衡功能进行定量测评，探讨不同亚型平衡功能特点以及亚型之间的差异。方法 使用平衡功能测试仪测量116例AD-HD患儿和34例正常儿童在8种不同状态下维持平衡的能力，分析不同亚型平衡功能特点。结果 注意缺陷亚型在除固定平面睁眼和左脚站立睁眼以外的6种状态下，摇摆速率均显著高于对照组(P&;lt;0．05)；多动-冲动亚型在固定平面闭眼、海绵垫平面睁眼及闭眼、单脚站立闭眼状态下，摇摆速率均显著高于对照组(P&;lt;0．05)；混合亚型在除右脚站立闭眼以外的7种测试状态下，摇摆速率均显著高于对照组(P&;lt;0．05)。多动-冲动亚型在海绵垫平面闭眼状态下的摇摆速率(2．5&;#177;0．8)％比混合型(2．0&;#177;0．7)％和注意缺陷亚型(2．0&;#177;0．8)％都高，差异有显著性意义(P&;lt;0．05，P&;lt;0．01)。结论 不同亚型ADHD患儿的平衡功能较正常儿童均有损害，混合型患儿功能缺陷最严重。3种亚型视觉与本体感觉系统的损害程度相似，多动-冲动亚型前庭系统功能的损害较混合型和注意缺陷亚型为重。     

注意缺陷多动障碍儿童记忆和执行功能的研究

背景：注意缺陷多动障碍(attentional deficit hvperkinetic disorder，ADHD)儿童的注意缺陷和学习困难国内研究较多，但对其记忆和执行功能的研究报道较少。目的：评估ADHD的记忆和执行功能。设计：以诊断为依据的病例对照研究。地点和对象：病例组患儿共45例，为2001-08／2002-02到镇江市第四人民医院门诊就诊的儿童，男39例，女6例，年龄7～14岁。对照组儿童共45例，为镇江市某小学1～6年级学生，男39例，女6例，年龄7～14岁。方法：采用儿童韦氏智力量表中的数字广度测验和韦氏记忆量表中的逻辑记忆和视觉记忆及威斯康星卡片分类测验分别对45例正常儿童和45例ADHD患儿进行检测。主要观察指标：ADHD患儿和正常儿童记忆之间以及ADHD各亚型之间的执行功能的比较。采用龚耀先标化的中国韦氏儿童智力量表及威斯康星卡片分类测验评定记忆和执行功能。结果：ADHD组中的数字广度、逻辑记忆、视觉记忆和威斯康星卡片中的总测验次数、正确反应数、持续错误数、非持续错误数以及分类数(15．12&;#177;2．00，9．98&;#177;4．16，17．06&;#177;3．83，105．52&;#177;24．75，21．17&;#177;3．43，45．87&;#177;21．02，22．99&;#177;8．47，1．09&;#177;0．31)与正常对照组(22．23&;#177;1．08，20．17&;#177;2．72，21．88&;#177;6．15，63．36&;#177;12．37，41．13&;#177;10．25，23．97&;#177;7．12，10．68&;#177;5．80，3．91&;#177;1．68)比较，差异有显著性意义(t=4．46-20．98，P&;lt;0．01)；ADHD组中的3个亚型(多动-冲动型、注意缺陷型及混合型)各项目评分比较，除多动-冲动型的逻辑记忆与其他两型有差异显著性意义(P&;lt;0．01)外，其他项目评分比较无差异显著性意义。结论：A：DHD存在短时记忆和执行功能损害。     

Acute effect of methylphenidate on QT interval duration and dispersion in children with attention deficit hyperactivity disorder

Among childhood psychiatric disorders, attention deficit hyperactivity disorder (ADHD) is of greatest interest to practitioners. Methylphenidate (MPH) is a drug that is widely used in the treatment of children in whom ADHD has been diagnosed. Although this treatment has been used for years, its effects on the heart remain the subject of debate. The QT interval comprises the ventricular activation and recovery periods as seen on electrocardiogram (ECG). The acute effect of MPH on QT interval dispersion is unknown. Researchers in the present study sought to investigate the acute effects of MPH on QT interval as seen on ECG. A total of 25 patients with ADHD (mean age, 9.4±2.1 y) who were treated with MPH were enrolled in the study. Twelve-lead derivation ECGs were taken before and 2 h after administration of 10 mg of MPH. Maximum QT interval, minimum QT interval, and interval durations were measured, and QT dispersion was calculated, for each ECG. QT dispersion measured after medication administration decreased significantly from 59.6±16.3 ms to 50.8±10.9 ms (P=.016); corrected QT dispersion decreased significantly from 70.9±17.6 ms to 61.3±13.3 ms (P=.011). Maximum QT interval duration decreased from 373.7±21.8 ms to 361.8±29.0 ms (P=.006); minimum QT interval duration rose from 317.0±23.3 ms to 322.3±21.6 ms (P=.312). In conclusion, the findings of this study show that MPH reduces QT dispersion during the acute period shortly after its administration.     

托莫西汀与哌甲酯缓释片治疗注意缺陷多动障碍对照研究

目的：探讨托莫西汀与哌甲酯缓释片治疗注意缺陷多动障碍患儿的临床疗效和安全性。方法将48例注意缺陷多动障碍患儿随机分为两组,每组24例,研究组口服托莫西汀治疗,对照组口服哌甲酯缓释片治疗,观察8周。治疗前后采用Conners儿童行为问卷,数字划销测验评定临床疗效,随时记录治疗过程中出现的不良反应。结果治疗后两组Conners儿童行为问卷评分学习问题、冲动‐多动、多动指数3个因子分及数字划销测验失误率较治疗前显著下降（P＜0.05或0.01）,治疗第4周、8周末两组有效率比较差异无显著性（P＞0.05）。两组不良反应均较轻微,研究组主要表现为食欲下降、头晕、日间困倦、体质量下降等,对照组主要表现为食欲下降、体质量下降、头痛及入睡困难等。结论托莫西汀与哌甲酯缓释片治疗注意缺陷多动障碍患儿疗效显著,总体疗效相当,安全性高,依从性好。     

Self-concept in children and adolescents with attention deficit hyperactivity disorder

Children with attention deficit hyperactivity disorder (ADHD) struggle with behavioral symptoms, yet little research has provided information about how behavioral symptoms impact their self-concept, especially in terms of gender, age, and ethnicity. Data were collected from 145 children and adolescents with ADHD and their mothers. African Americans, Hispanic Americans, and Caucasians were nearly equally represented in the sample, with approximately one third each. The Child Behavior Checklist was used to assess ADHD symptom severity, and Piers--Harris Children's Self-Concept Scale was used to measure self-concept. Older ages and more internalizing behavior problems predicted lower self-concept. There were no significant differences between ethnic groups on behavior problem and self-concept scores, although post hoc analyses revealed a trend for Caucasian children with ADHD to have lower self-concept scores than those of African American or Hispanic children. The findings indicate that there is a need to assess self-concept in children and adolescents with ADHD, especially those who are older and have comorbid conditions of anxiety and depression.     

多动症患儿自我意识水平现状调查

目的调查多动症(attention deficit and hyperactivity disorder,ADHD)患儿自我意识水平现状,为临床开展健康教育提供依据。方法比较ADHD患儿与全国常模自我意识水平的差异,并采用Piers-Harris儿童自我意识量表对ADHD患儿和正常儿童各30例进行对照分析。结果ADHD患儿自我意识量表行为、智力与学校、焦虑、合群、幸福与满足等因子分及总分较对照组低,差异具有统计学意义(P<0.01)。结论ADHD患儿自我意识水平普遍偏低,需进行早期护理干预,纠正患儿的不健康行为,培养自尊心和自信心,提高自我意识水平。     

Acute myocardial infarction related to methylphenidate for adult attention deficit disorder

Adult Attention Deficit Disorder is increasingly diagnosed and treated. Psychostimulant medications, such as methylphenidate, are commonly prescribed for this condition, but the long-term safety of such medications in an adult population is unknown at present. Because these medications are closely related to amphetamines, it is expected that toxic side effects would be similar. We present the case of a 27-year-old man who suffered an acute myocardial infarction due to coronary vasospasm related to use of methylphenidate complicated by concomitant use of pseudoephedrine.     

精神分裂症探究性眼动分析与P300电位研究

目的探讨精神分裂症患者探究性眼动分析与P300电位对精神分裂症患者的诊断价值。方法对42例精神分裂症患者和40例正常健康者分别进行探究性眼动分析与P300电位测定．并进行比较分析。结果精神分裂症组中探究性眼动分析和P300电位测定的异常率分别为85．7％和81．0％．两者异常吻合率为76．2％。精神分裂症组探究性眼动测定结果中凝视点和反应探索评分值显著低于对照组（P〈0．01），P300电位测定中N2、P3波潜伏期和P3波幅较对照组分别延长和降低（P〈0．01）。结论探究性眼动分析和P300电位测定可作为精神分裂症患者的诊断指标应用于临床。     

Herbal medicines in children with attention deficit hyperactivity disorder (ADHD): A systematic review

ObjectiveThe purpose of this review is to identify evidence in herbal therapy in the treatment of ADHD concerning effectiveness and drug tolerability.MethodFor this Medline/PubMed, Scopus and the Cochrane Central Register of Controlled Trials (Central) were searched from their inception to 15 July 2016. Only randomized controlled trails (RCT) with children (0–18 years) suffering from ADHD were included in this review.ResultsNine RCTs with 464 patients comparing herbal pharmaceuticals to placebo or active control were included. Seven different herbs were tested in the treatment of ADHD symptoms. Low evidence could be found for Melissa officinalis, Valeriana officinalis and Passiflora incarnata. Limited evidence could be found for pine bark extract and Gingko biloba. The other herbal preparations showed no efficacy in the treatment of ADHD symptoms.ConclusionWhile there is still a lack of sufficient numbers of RCTs no concrete recommendations for use can be made so far.     

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.