注意缺陷多动障碍儿童的情绪能力特点

注意缺陷多动障碍(ADHD)儿童普遍存在持续的注意力不集中、过度活跃、易冲动等临床症状。其中,情绪能力障碍是ADHD的临床表现之一,本文梳理了ADHD儿童在面部情绪识别、情绪反应、情绪调节上的特点及其与行为问题的关系,以及ADHD儿童情绪能力障碍的神经生理机制,为更深入地了解ADHD儿童的情绪能力特点提供一些参考,并在此基础上提出未来研究的可能方向。     

虚拟现实技术在注意缺陷多动障碍诊疗中的应用

虚拟现实技术为儿童精神疾病的诊断、干预和治疗带来了革命性的进步。本文梳理了虚拟现实技术在改善注意缺陷多动障碍(ADHD)儿童持续性注意、社交技能、情绪识别、时间感知、执行功能及冲动行为等方面的应用,并总结了虚拟现实技术在ADHD诊疗中应用的优势、局限和前景。     

注意缺陷多动障碍儿童家庭环境特征和行为问题与社会功能损害关系的研究

目的 分析注意缺陷多动障碍(ADHD)儿童家庭环境特征和行为问题与社会功能损害之间的关系,为ADHD的临床诊断和治疗提供科学依据。 方法 选取2017年9月-2018年11月徐州市儿童医院140名ADHD儿童作为观察组,同时招募120名健康儿童作为对照组。采用自行设计的问卷、中文版家庭环境量表(FES-CV)、Conners父母评定量表(CPRS)、Conners教师评定量表(CTRS)和Weiss功能缺陷量表父母版(WFIRS-P)、现场行为观察法对儿童进行评估。采用Logistic回归模型预测ADHD风险因素。 结果 随着母亲受教育程度(OR=1.16,8.80,9.20)、职业地位(OR=0.89,2.24,2.35,5.90)和情绪稳定程度(OR=1.74)的降低,儿童ADHD风险呈上升趋势;父亲职业和教育水平、情绪状态与上述结果相似。ADHD儿童中文版家庭环境量表(FES-CV)中仅矛盾性分量表差异具有统计学意义(t=4.342,P<0.001)。ADHD儿童在所有6个Weiss功能缺陷量表父母版(WFIRS-P)的分量表测试中均表现出损伤[最低维度得分(0.19±0.22)分,健康儿童最高维度得分为(0.19±0.20)分,P<0.001)]。Conners父母评定量表(CPRS)和Conners教师评定量表(CTRS)除心身障碍维度外,其余差异均有统计学意义(P<0.001)。 结论 ADHD儿童与健康儿童相比,较差家庭环境、父母较低教育水平、更糟的职业状况和父母情绪不稳定可能会增加儿童的ADHD风险,且与儿童行为问题和社会功能损害相互作用。因此,早期以折中因素为重点的干预有助于改善ADHD儿童的社会行为功能。     

Autistic spectrum disorder traits in children with attention deficit hyperactivity disorder

Background Current classification systems do not allow for comorbid diagnoses of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). Children with ADHD are often screened for ASD during clinical assessment and when recruited to clinical trials. We predicted that children with ADHD would have more autistic traits than controls and that certain traits would be more prevalent. Methods The clinically referred sample consisted of 30 children with ADHD and 30 matched controls aged 9–15 years. Children were screened for ASD traits using the Social Aptitudes Scale (SAS) and the Social Communication Questionnaire (SCQ). Results We found that ASD traits were significantly higher in children with ADHD than controls. None of the children received a diagnosis of autism or ASD. However, a large proportion (28% using the SCQ and 62% using the SAS) of children with ADHD reached screening thresholds for a predictive diagnosis of ASD. Relative to controls, children with ADHD had significantly higher levels of communication and social deficits, but not repetitive behaviours. Conclusion Further work is needed to establish whether autistic‐like communication and social difficulties in children with ADHD are part of the broader ASD phenotype or are specific to ADHD.     

学龄期多动障碍合并双相障碍的行为研究

目的：讨论学龄期注意缺陷多动障碍（ ADHD）和双相障碍（ BD）共病患儿的临床行为特点。方法对浙江省湖州市第三人民医院门诊及院部收治的68例ADHD患者资料进行随访观察,其中有17例患者合并BPD,对单纯组和合并组的行为特点采用Achenbach儿童行为量表CBCL统计分析,记录各行为参数评分,并对两组各评分进行比较分析。结果两组患者在社交问题（t＝-3．552,P＜0．05）,注意问题（t＝-4．228,P＜0．05）,违纪行为（t＝-5．618,P＜0．05）,攻击行为（t＝-6．910,P＜0．05）,外化问题（t＝-6．998,P＜0．05）,行为总分（t＝-7．991,P＜0．05）几个方面比较具有显著统计学意义;在焦虑抑郁（t＝-2．511,P＜0．05）,思维问题（t＝-1．981,P＜0．05）两方面比较也具有显著统计学意义。结论精神科医生在对患者进行诊断时,针对行为问题居多的ADHD患儿,要进行详细的诊断分析,避免对BD造成误诊与漏诊。     

共患注意缺陷多动障碍对学龄阿斯伯格综合征儿童学业及社交功能损害的影响

目的 探讨共患注意缺陷多动障碍(ADHD)对学龄阿斯伯格综合征(AS)儿童学业及社交功能损害的影响。方法 应用Vanderbilt ADHD评定定量表对门诊确诊的90例学龄AS患儿(男85例,女5例)进行评估,年龄6.0~14.0岁,平均(9.11±2.11)岁。其中共患ADHD 44例,分别评定共患ADHD及单纯AS儿童的学业及社交功能损害情况并进行比较。结果 共患ADHD的AS组其学业以及社交功能损害程度均较无共患ADHD的AS组严重,差异均有统计学意义(P<0.01)。结论 共患ADHD学龄AS儿童存在更为严重的学业及社交功能损害。     

儿童、青少年注意缺陷多动障碍的评估及管理

注意缺陷多动障碍(ADHD)是一种慢性神经发育障碍,可能持续终生。对怀疑可能患有ADHD的儿童、青少年应启动诊断评估。临床诊断应建立在综合评估的基础上。应按照慢性病管理模式来管理ADHD,制定完善的治疗计划。父母培训/行为干预、药物治疗是得到证据支持的最有效治疗方法。影响治疗选择的主要因素有患者年龄、疾病严重程度及共患病。行为干预是学龄前儿童首选的治疗方法,对于学龄期儿童、青少年首选药物治疗,联合或不联合行为。     

注意缺陷多动障碍与抽动障碍共病儿童的行为特征研究

【目的】 探讨注意缺陷多动障碍(attention deficit hyperactivity disorder, ADHD)与抽动障碍(tic disorder,TD)共病(comorbid attention deficit hyperactivity disorder and tic disorder, CAT)患儿的行为特征。 【方法】 采用Achenbach儿童行为量表(Child Behavior Checklist,CBCL)对注意缺陷多动障碍与抽动障碍共病(CAT)组60例,ADHD组79例,TD组60例,正常对照组71名儿童分别进行评估。 【结果】 CAT组行为问题发生率与ADHD组比较差异无统计学意义(χ²=0.419,P＞0.05);CAT组行为问题发生率显著高于TD组(χ²=7.745,P<0.01);CAT组与正常对照组比较差异有高度统计学意义(χ²=27.326,P<0.001)。男童CAT组强迫性与攻击性因子显著高于ADHD组(P<0.01),交往不良因子略高于ADHD组(P<0.05)。CAT组除分裂性因子外其余因子均显著高于TD组(P<0.01)。CAT组所有九个因子均显著高于对照组,差异有高度统计学意义(P<0.01)。女童CAT组各因子与ADHD组比较均无差异;CAT组的攻击因子高于TD组,差异具有统计学意义(P<0.05);CAT组社交退缩、攻击因子高于对照组,差异具有统计学意义(P<0.05)。 【结论】 CAT儿童存在更多及更为严重的行为问题,ADHD的存在是CAT儿童行为问题的主要来源, CAT男童患者行为问题更加严重。     

学龄前儿童注意缺陷多动障碍的干预进展

注意缺陷多动障碍(ADHD)是儿童时期常见的神经发育障碍性疾病,以注意力不集中、多动及冲动为主要症状,在学龄前期主要表现为多动。ADHD对患儿的学业成绩、人际交往、身心发育等多方面产生严重负面影响,并可持续到青春期或成年期。早期干预可以减轻ADHD核心症状,减少共患病发生率。目前学龄前ADHD的干预手段包括行为治疗、物理治疗、药物治疗等。药物治疗可明显改善ADHD核心症状,但无法改善学龄前儿童的社交和情绪问题,且药物副反应会造成成瘾、依从性差等问题。行为治疗不仅可以改善患儿的社交功能和情绪,减轻父母养育压力,且不存在药物副作用等问题,成为当下的研究热点。本文对学龄前ADHD儿童的干预进展进行综述。     

行为矫正对儿童注意缺陷多动障碍的干预作用

目的 观察基于社会技能训练的“行为矫正”对儿童注意缺陷多动障碍(ADHD)的干预效果,为临床治疗提供参考依据。方法 将100例ADHD患儿随机分为干预组和等待组各50例。给予干预组为期12周的社会技能训练,同时应用以“正性强化”为主的多种“行为矫正”策略。采用ADHDRS-Ⅳ-Parent量表和Rutter父母问卷分别于基线和干预结束后进行行为评定,并对干预效果进行评价。结果 干预组儿童干预后ADHDRS-Ⅳ-Parent量表的总分和注意缺陷分、多动/冲动分均显著下降(P＜0.01),其中多动/冲动分的降分率高于注意缺陷分;Rutter父母问卷的总分和A分、N分均明显降低(P＜0.01或＜0.05);患儿、家长和老师均认为满意,其中患儿的满意率最高,老师的满意率最低。结论 “行为矫正”训练对治疗ADHD有较好的干预效果。     

儿童常见发育异常性疾病的情绪行为与社交功能问题

孤独症谱系障碍(ASD)、注意缺陷多动障碍(ADHD)和语言障碍(LD)等神经发育障碍性疾病是儿童常见的发育异常性疾病,常伴心理行为与社交功能问题,早期识别、诊断和早期针对性的干预措施,对改善其预后具有重要意义。本文就儿童常见发育异常性疾病的心理行为与社交功能进行介绍,供相关专业人员参考。     

注意缺陷多动障碍儿童的执行功能

执行功能缺陷是注意缺陷多动障碍(ADHD)的核心缺陷,对执行功能评估及干预的研究为儿童精神疾病的诊断、干预和治疗提供了依据。本文梳理了执行功能的评估手段、神经解剖学基础以及ADHD儿童执行功能的特点,并总结了执行功能的评估结果在ADHD诊疗中的意义、局限和前景。     

Ethical considerations for research involving boys diagnosed with attention-deficit/hyperactivity disorder

The ‘new sociology of childhood’ has activated a growing interest in children as social actors and their level of involvement in activities that affect their lives. In the field of research, debate is underway regarding the consent processes and methodological activities that support child participation. This paper highlights methodological and ethical considerations that emerged while engaging in research with young boys (aged 9–11 years old) with a formal diagnosis of attention-deficit/hyperactivity disorder (ADHD). Key issues include recruitment, informed consent, and participatory activities for data production. Sociocultural theories of childhood and disability are applied to reflect on the power and privilege operating through the research process. Engaging in research that involves children with disabilities, in which discourses of risk, stigma, and protection are elevated, problematizes the researcher–researched relationship and expands considerations of what constitutes ethical practice and ‘valuable data’.     

学龄前儿童注意缺陷多动障碍筛查量表的研究进展

注意缺陷多动障碍(ADHD)是一种常见的儿童行为问题,常在学龄期被诊断,但在学龄前期已经表现出较多的行为问题,因此,早期诊断注意ADHD成为一种趋势。本文对国内外关于学龄前儿童ADHD评估量表的研究进展进行了总结整理。     

邻苯二甲酸酯与儿童注意缺陷多动障碍关联的研究进展

随着环境问题日益严重,环境污染物对儿童神经心理行为发育的影响成为社会关注的热点问题。注意缺陷多动障碍(ADHD)是儿童期最普遍、最常见的心理与行为障碍之一,环境毒物对于儿童ADHD症状、疾病存在一定的贡献。越来越多的毒理学和流行病学证据表明,邻苯二甲酸酯(PAEs)与儿童ADHD症状、疾病可能存在关联,二者间的关联可能涉及到多巴胺神经元系统、甲状腺系统、氧化应激及睾酮修饰的异常。明确PAEs与儿童ADHD的关联及内在机制,对于深入探索ADHD病因学和病理机制至关重要。     

药物治疗对注意缺陷多动障碍患儿体格生长影响的研究进展

注意缺陷多动障碍(ADHD)是儿童时期最常见的神经发育障碍性疾病,对儿童的学业水平、人际交往、社会功能以及整个家庭、社会都有不可忽视的影响。ADHD的发病率在过去几十年里一直呈上升趋势。兴奋剂哌甲酯(MPH)与选择性去甲肾上腺素再摄取抑制剂托莫西汀(ATX)均为治疗ADHD公认的一线药物。药物对ADHD儿童体格生长可能带来的消极影响令家长担忧。本文就药物治疗对ADHD患儿体格生长的影响、相关机制及管理进行综述,以期提高患儿临床药物治疗的依从性。     

The implications of having attention-deficit/hyperactivity disorder in male adolescents with intellectual disability

Attention-deficit/hyperactivity disorder (ADHD) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. The purpose of this study was to demonstrate a correlation between social skills and ADHD among adolescents with intellectual disabilities (ID). The study concerns the specific cognitive and adaptive skills of adolescents dually diagnosed with mild intellectual disabilities and comorbid pathology as ADHD. Three age-and IQ-match groups (males, n = 12 in each group) were investigated. Group I--composed of adolescent diagnosed with mild ID, group II--adolescents diagnosed with ADHD, and group III--adolescents diagnosed with ID and ADHD. The instruments used in the study were Wechsler Intelligence Scale for Children (WISC, according to the chronological age of the subjects) and the short version of the Developmental Behavior Checklist (DBC). Results confirm that comorbidity is a factor differentiating. ADHD strongly increased the impairment of social skills, while behavioral disorders were less damaging in ID performance. The WISC and DBC instruments should be used with confidence in clinical and service settings, to allow a better assessment of co-occurrence morbidity in adolescents with ID. The interactions between intellectual disability and psychopathology behavior highlight the need to plan a more accurate diagnosis and appropriate rehabilitative intervention program, essential for improving the quality of life of the ID population.     

注意缺陷多动障碍儿童的社会适应行为特征

注意缺陷多动障碍是目前儿科心理门诊最多见的行为疾病之一。这类儿童注意力难以集中 ,行动缺乏控制力 ,易冲动、攻击 ,同时伴有情绪调节障碍 ,如抑郁、焦虑、沮丧、悲观等。注意缺陷多动障碍儿童在家庭与父母难以沟通 ,在学校成绩低下 ,学业不好 ,人际交往不良 ,缺乏社会知识及技能 ,有的甚至发展为反社会行为 ,给社会带来危害。这些适应不良行为与注意缺陷多动障碍的基因、注意缺陷多动障碍亚型、个性特征、合并症、智力与父母性格息息相关     

The role of disability living allowance in the management of attention-deficit/hyperactivity disorder

OBJECTIVE: To explore the use of Disability Living Allowance (DLA) by families of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD), and to discuss the implications for clinicians involved in their treatment. STUDY DESIGN: Opportunistic survey of patients attending ADHD clinic. SETTING: Urban area in the north-east of England. SUBJECTS: A total of 32 carers of children being treated for ADHD with methylphenidate. INTERVENTION: Semi-structured telephone interviews about receipt and use of DLA. This involved open and closed questions and a multiple-choice section. RESULTS: In total, 19 out of the 32 families were receiving DLA. They chose to use it mainly to replace clothes and furniture and to provide diversions and activities for the children concerned. Some families were unaware of potential eligibility for DLA, whereas a few had chosen not to apply. Only one family's application for DLA had been unsuccessful. Carers were unanimously positive about the extra income. CONCLUSIONS: Families view DLA as an important means to replace damaged items and to fund recreational activities to contain over-activity. Families receive little formal guidance on ways of using DLA money to support children with ADHD. Virtually no specific training in benefits awareness is provided to general practitioners and child health specialists, who are often asked to judge the child's level of impairment or incapacity. Applying for DLA may affect the therapeutic relationship for good or ill. There is a need for professionals in contact with children with ADHD to inform families of the possibility of receiving DLA and support them in applications. As diagnosis and treatment of ADHD becomes more commonplace, more families are likely to be entitled to claim DLA. This has definite implications for the social security budget.