儿童注意缺陷多动障碍脑电图特点与临床分析

注意缺陷多动性障碍(ADHD)，又名儿童多动症，是一种最为常见的儿童行为问题，临床上以注意力集中困难，多动或行为冲动但智力基本正常等表现为特征。现将我院1998～2003年在我科门诊就诊的ADHD患儿脑电图特点与临床特点分析报告如下。     

儿童注意缺陷多动障碍脑电图特点与临床分析

儿童注意缺陷多动障碍 (ADHD)又称儿童多动症 ,是一种常见儿童行为障碍综合征。现将我院 1995年 2月～ 2 0 0 2年 5月 5 2例ADHD患儿脑电图 (EEG)特点与临床关系分析如下。资料与方法一、一般资料　采用美国DAM -Ⅱ诊断标准[1] ,确诊ADHD 5 2例 ,男 4 4例 ,女 8例 ;年龄 4～ 16岁 ,8～ 11岁 36例 ,占 6 9.2 %。二、临床表现　ADHD最常见和突出症状是注意力集中困难 ,活动多 ,情绪不稳定 ,冲动、任性及学习困难。 35例表现为注意力短暂、难以集中且分散 ;10例活动过度 ;4例学习困难 ;3例易哭闹、发怒、冲动、任性。三、检查方法　采…     

多不饱和脂肪酸与注意缺陷多动障碍

注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童青少年期常见的心理行为障碍,其主要临床特征为注意力不集中、活动过度和行为冲动.ADHD的发病机制及病因至今不明,多数学者认同ADHD是生物-心理-社会因素共同作用形成的疾病模型.生物学因素包括生物化学、遗传学、免疫学、神经系统发育障碍、脑电生理、影像学等.近年来,人体营养状况与精神心理健康的关系愈来愈引起研究人员注意,也不断有学者报道儿童青少年营养状况与ADHD存在一定的相关性,其中多见多不饱和脂肪酸(polyunsaturated fatty acid,PUFA)与ADHD关系的研究,以及锌元素、镁元素在脂肪酸(fatty acid)与ADHD中的作用.本文在查阅相关文献基础上,仅就此方面做一综述.     

注意缺陷多动障碍儿童的睡眠结构研究

目的探讨注意缺陷多动障碍(ADHD)儿童的睡眠结构。方法2005-06—2006-04用多导睡眠监护仪(PSG)对首都儿科研究所神经内科就诊的41例ADHD患儿及30例正常儿童进行全夜睡眠结构检测。结果41例ADHD儿童中混合型(ADHD-C)24例、注意缺陷型(ADHD-I)11例、多动/冲动型(ADHD-H)6例。其中男35例,女6例(ADHD-I3、ADHD-C2、ADHD-H1例)。与对照组比较ADHD组REM潜伏期短、睡眠潜伏期延长、睡眠效率降低,差异有显著性(P<0·05);ADHD-C儿童睡眠Ⅱ期百分比较ADHD-I增加,差异有显著性(P<0·05);ADHD组睡眠周期性肢体运动(PLMS)发生率为41·5%,正常组PLMS发生率为13·33%,差异有显著性(P<0·05);ADHD组及正常对照组脑电图未见疒间性放电。结论(1)ADHD儿童存在REM睡眠结构的改变、入睡困难及睡眠效率降低;(2)PLMS也是导致ADHD儿童睡眠质量下降的原因之一;(3)ADHD儿童以男孩为主,女孩以注意力缺陷型为主。对学习困难的女孩应注意是否患有ADHD。     

儿童注意缺陷多动障碍的诊断进展

尽管对注意缺陷多动障碍 (ａｔｔｅｎｔｉｏｎ ｄｅｆｉｃｉｔｈｙｐｅｒａｃｔｉｖｉｔｙｄｉｓｏｒｄｅｒ,ＡＤＨＤ)进行了大量的研究 ,但其仍是较难诊断的儿童精神障碍之一。由于ＡＤＨＤ缺乏具鉴别意义的病因学或病理学改变 ,主要靠特殊行为症状来确诊 ,因此给诊断一致性带来困难。一、ＡＤＨＤ的发展史早在 19世纪末 ,人们就认识到儿童的多动症状。Ｓｔｉｌｌ和Ｅｂａｕｇｈ等描述了在精神发育迟滞和严重神经系统损害儿童中的“不安宁、冲动、注意力不集中及多动”表现。 2 0世纪 4 0年代 ,Ｓｔｒａｕｓｓ等认为这类症状与脑损伤有关 ,…     

儿童血铅与注意缺陷多动障碍的相关性

目的研究儿童血铅水平与注意缺陷多动障碍(ADHD)的相关性。方法对100名儿童进行血铅水平测定,据其血铅水平分为血铅水平正常组(对照组)及血铅水平增高组(实验组)各50例,再对两组儿童分别进行Conners量表测查,研究Conners量表分值与血铅水平的相关性。结果血铅水平正常组Conners量表分值明显低于铅中毒组,两组比较有显著差异(P <0.01),且血铅水平与Conners量表分值呈显著正相关(P<0.01)。结论通过血铅水平的测定,可早发现、早诊断ADHD,有利于进行早期干预,从两改善其预后。     

注意缺陷多动障碍儿童的家庭环境研究

目的探讨注意缺陷多动障碍(ADHD)儿童家庭环境特点,以了解其可能的环境病因。方法根据DSM-IV诊断标准对儿保门诊因多动、注意问题、成绩下降而就诊的148例儿童进行诊断,并对就诊儿童采用自编问卷由就诊父母在专业人员的指导下当场填写。结果ADHD儿童的父母在教育上是斥责打骂、陪读加督促;在家庭生活中,父母更多地体验到不开心,感觉很累,常为孩子的学习差而焦虑,并且出现了更多的亲子关系问题。结论父母的教、养及其本身的情绪问题与儿童ADHD的发生有一定的关系。     

儿童注意缺陷多动障碍的临床研究

注意缺陷多动障碍是儿童期尤其是学龄期儿童最常见的精神障碍之一，也是学龄期儿童患病能够屡最高的慢性健康问题。以注意力不集中、活动过度和冲动性为特征。ADHD易共患其他精神障碍。ADHD 的核心症状多动、冲动和注意缺陷对患病儿童的认知功能造成了一定的影响，直接影响了患儿的学习和生活，因此对本病正确诊断和治疗十分重要。本文综述了儿童注意缺陷多动障碍的诊断及治疗的进展。     

儿童注意缺陷多动障碍诊疗进展

注意缺陷多动障碍(ADHD)是儿童最常见的慢性神经精神疾病之一,多起病于7岁前,持续影响患儿的认知、情绪、行为、生活质量及社会功能,约2/3可持续至青春期或成年期,大多共患其他类行为或情绪问题/障碍。ADHD的病因涉及出生缺陷、遗传、神经心理发育异常、家庭与环境等影响因素,是生物-心理-社会诸因素导致的病症。临床通常采用药物治疗,并结合心理指导和行为矫治。现就ADHD的病因及诊疗研究进展做一简略概述。     

儿童注意缺陷多动障碍的神经心理缺陷研究进展

注意缺陷多动障碍(ADHD)是一种常见的儿童行为问题,以注意维持的缺损、冲动性及多动性为其主要特征。近些年,ADHD儿童在各种神经心理功能领域上的缺陷均得到了证实,其中包括智力、注意与抑制、言语和空间工作记忆、定势转换、计划和监控等。一些有关ADHD心理机制的重要理论也被相继提出,其中代表性的有反应抑制模型、认知能量模型、双通道理论和状态调节理论。     

注意缺陷多动障碍儿童的社会适应行为特征

目的探讨了解注意缺陷多动障碍(ADHD)儿童社会适应行为特征、个性特征及其相关关系。方法采用国内修订版儿童适应行为评定量表(ADQ)、Achenbach儿童行为量表(CBCL)和艾森克个性问卷儿童版(EPQ),对2003-04—2004-01在广州市儿童医院精神康复科就诊的67例7~12岁ADHD儿童(ADHD组)和相同年龄的85例正常儿童(对照组)进行了测评比较分析。结果ADHD组在ADQ量表中感觉运动分低于对照组(P<0.05),语言发展、个人取向、社会责任、社会自制因子、适应能力商数分低于对照组(P<0.01)。在CBCL中,ADHD组的活动能力、交际能力、学校情况分值均低于对照组(P<0.01),ADHD组有明显的社交退缩倾向(P<0.05),他们更容易发生抑郁、体诉、多动、攻击等行为表现(P<0.01),其中体诉、违纪两个因子是ADHD的危险因子,对ADHD的发生具有预测性。在EPQ中,ADHD组的P分、N分值明显高于对照组(P<0.01),而L分则低于对照组(P<0.01),E维度对ADHD儿童有社会自制行为影响明显。结论ADHD儿童社会适应水平低下和不良人格倾向,并且伴随多种与适应不良有关的问题行为。     

Sleep patterns in children with attention-deficit/hyperactivity disorder, tic disorder, and comorbidity

BACKGROUND: In children, attention-deficit/hyperactivity disorder (ADHD), tic disorder (TD), and their coexistence (ADHD + TD comorbidity) are very common and clinically important. Associated sleep patterns and their clinical role are still insufficiently investigated. This study aimed at characterizing these sleep patterns in children with ADHD, TD, and ADHD + TD comorbidity and determining whether, in ADHD + TD, the factors ADHD and TD may affect the sleep pattern in an independent (additive) or in a complex (interactive) manner. METHOD: By means of polysomnography, sleep patterns were investigated in 4 groups of unmedicated 8.0-16.4-year-old children (healthy controls, ADHD-only, TD-only, and ADHD + TD). Each group consisted of 18 subjects matched for age, gender, and intelligence. RESULTS: ADHD was primarily characterized by increase in rapid eye movement (REM) sleep, whereas TD patients displayed lower sleep efficiency and elevated arousal index in sleep. In children with ADHD + TD, both effects appeared. No interaction between the ADHD and TD factors was found for any of the sleep parameters. Significant correlations between sleep patterns and clinical symptoms were found. CONCLUSIONS: ADHD and TD are characterized by specific sleep alterations. When coexisting, the two disorders alter the sleep pattern in an additive manner, suggesting a high impact on clinical and therapeutic perspectives.     

Response to methylphenidate in boys with attention-deficit hyperactivity disorder

The response to methylphenidate was examined in 36 boys, aged 7-11 y, with attention-deficit hyperactivity disorder (ADHD) in a double-blind, placebo-controlled, crossover design. Hyperactivity and conduct problems were significantly reduced during methylphenidate treatment. Stimulant medication was associated with improvements on tests of sustained attention, working memory and motor steadiness. When individual changes were studied, it was found that 83% showed a significant improvement in their hyperactivity at home or at school, and for 60% their levels of hyperactive behaviour were within the normal range. High levels of hyperactivity at school and relatively low age were significant predictors of normalization of hyperactivity in at least one setting. However, these predictors could only classify correctly 71% of the children. In clinical practice a trial with stimulants is indicated in ADHD children who show symptoms that are sufficiently severe to cause impairment at home and at school.     

A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder

Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children.     

Extended-release medications for children and adolescents with attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) affects one in 20 Canadian children, and is associated with unfavourable academic and employment records, high rates of injury and substance abuse, poor interpersonal relationships, poor mental health outcomes and poor quality of life. Medications have been shown to be efficacious in treating ADHD symptoms in controlled trials, and are associated with better social and health outcomes in observational studies. Extended-release (XR) medications for ADHD are preferred over short-acting immediate-release medications by many families and their treating physicians. The XR preparations are often unaffordable for affected families who are disproportionally among the lower socioeconomic strata.The objective of the present statement was to critically appraise the evidence for the relative effectiveness of XR versus immediate-release medications, and to make recommendations for their appropriate use in the treatment of ADHD.When medication is indicated, XR preparations should be considered as first-line therapy for ADHD because they are more effective and less likely to be diverted. Future research and cost-benefit analyses should consider both efficacy and effectiveness, and the diversion and misuse potentials of these medications. Industry, insurance companies and government must work together to make these medications accessible to all children and youth with ADHD.     

儿童注意力缺陷多动障碍与ABO血型基因的关联

目的：探讨儿童注意力缺陷多动障碍（ADHD）与ABO血型基因的关联趋势。方法：应用玻片法检测96名ADHD儿童及其父母的血型,聚合酶链反应-限制性片段长度多态性检测血型的O基因。同时应用基于单体型的单体型相对风险分析患者组与父母内对照组,进行传递不平衡检验和卡方检验。结果：①96名患者与父母内对照组ABO血型基因传递不平衡检验得出χ2=6.017,df=2,P<0.05。②父母A和B基因传递情况单独进行卡方检验得出χ2=3.289,df=1,P=0.07,父母O与B基因传递情况比较, χ2=3.629,df=1,P=0.057。患者中O、A基因明显多于B基因,差异接近显著性。结论：ABO血型基因与儿童ADHD有一定的关联趋势。O、A基因可增加ADHD的患病危险性,B基因可减少本病的危险性。［中国当代儿科杂志,2009,11（5）：371-373］     

Treatment experiences of children and adolescents with attention-deficit/hyperactivity disorder

Aim: To gain insight into the treatment experiences of children and adolescents diagnosed with attention‐deficit/hyperactivity disorder (ADHD). Methods: Convenience sampling was used to recruit eligible parents and carers at paediatric clinics of the Children's, Youth and Women's Health Service to participate in an interview to discuss experiences, using a semi‐structured questionnaire. Results: Thirty‐five interviews were conducted. Twenty‐five subjects had trialled an average of 1.5 interventions prior to receiving an ADHD diagnosis, namely, dietary modifications (46%), behavioural therapy (24%), learning assistance (8%) and natural remedies (8%). Following an ADHD diagnosis, 25 subjects tried an average of 2.8 interventions, most commonly behavioural therapies (48%), expressive therapies (48%) and fish oil (36%). All subjects started psychostimulant medication after receiving an ADHD diagnosis. Despite 52% of parents expressing initial reluctance towards psychostimulants, 97% reported positive experiences with use in terms of schooling, social interaction and family life. Of those being treated with psychostimulants, 22 (73%) were concurrently using other treatments at the time of interview. Conclusions: Few patients use psychostimulant medication in isolation, with the majority of parents using multiple approaches to manage their child's behaviour. Parents tried a variety of therapies before commencing psychostimulant medication, often because of fears regarding psychostimulant safety. Parents were generally happy with the results gained; however adolescents interviewed were less convinced of the benefits of psychostimulants.