用认知行为训练改进一小学生课堂注意行为的个案研究

目的：考察认知行为训练对一小学生课堂注意行为的辅导效果。方法：对个案进行四次认知行为训练，比较其在基线阶段、干预阶段和追踪阶段的课堂不注意行为次数是否存在显著性差异。结果：（1）在干预阶段和追踪阶段被试的课堂不注意行为（平均不到2次）显著低于训练前的基线水平（平均8次）；（2）与干预阶段相比，追踪阶段个案课堂不注意行为次数有所回升（平均2次）但没有达到显著性水平。结论：认知行为训练对于改进个案的课堂注意行为是有效的；在进行传统的行为矫正技术的同时采用自我指导训练，对于改进个案课堂注意行为可能有更为持续的效果。     

慢性抽动障碍儿童行为问题的对照研究

目的:比较伴与不伴注意缺陷多动障碍(ADHD)的慢性抽动障碍(CTD)儿童和ADHD以及正常对照儿童行为问题的差异。方法:对伴与不伴ADHD的CTD儿童和ADHD以及正常对照儿童采用儿童行为量表(CBCL)进行对比分析。结果:CTD ADHD组和ADHD组儿童总的行为问题发生率、CBCL多数因子分及行为问题总分与单纯CTD组和对照组比较,差异有统计学意义(P﹤0.05),而单纯CTD组和对照组两组间只有强迫、多动、攻击因子分和行为问题总分有统计学差异(P﹤0.05)。结论:伴有ADHD的CTD儿童与ADHD儿童相似,存在较高的行为问题发生率和较多的行为问题,提示伴有的ADHD是CTD儿童行为问题的主要来源。     

药物联合心理行为干预对42例注意缺陷多动障碍儿童的疗效分析

目的探讨药物联合心理行为干预治疗儿童的注意缺陷多动障碍的疗效。方法选取63例注意缺陷多动障碍儿童．分为对照组和治疗组,对照组单纯药物治疗,治疗组采用药物联合心理行为干预治疗。结果治疗组总有效率高于对照组（P〈0．03）。结论采用心理行为干预联合药物治疗注意力缺陷多动障碍患儿．疗效显著     

社会技能训练为主的综合心理治疗疗效观察——附12例注意缺陷多动障碍儿童疗效报告

目的 :探讨以社会技能训练为主的综合心理治疗对注意缺陷多动障碍儿童的疗效 ,并探索社会技能训练的方法。方法 :以社会技能训练为主的综合心理治疗对 12例注意缺陷多动障碍儿童进行为期 8周的治疗 ,用Rutter儿童行为问卷 ,Conners儿童行为问卷 ,Achenbach儿童行为量表进行疗效评价。结果 :治疗后 ,Rutter儿童行为问卷总分较治疗前显著下降 (t =5 487,P <0 0 0 1) ;Conners儿童行为问卷结果显示 ,总分 (t =3 3 75 ) ,行为因子分 (t =2 493 )、学习 (t =2 5 45 )、多动 (t =3 117)、多动指数 (t =2 43 2 )较治疗前显著下降 (p <0 0 5～ 0 0 1) ;Achenbach儿童行为量表显示部分患儿部分因子分下降。结论 :本研究所使用的社会技能训练方法切实可行 ,社会技能训练为主的综合心理治疗对降低注意缺陷多动障碍儿童的行为问题有效。     

5例注意缺陷多动障碍患儿自我管理技能训练的干预研究

目的：探索注意缺陷多动障碍患儿自我管理技能训练的方法，评估自我管理技能训练用于多动症患儿的治疗效果。方法：对5名多动症男孩进行为期6周的以自我管理技能训练为主的综合治疗，以Conners父母症状问卷、Achenbach儿童行为调查表作为治疗效果的评价工具。结果：治疗后．除1名儿童未见明显疗效外，其余4名儿童的行为问题均获得不同程度的改善。结论：本研究所采用的自我管理技能训练计划切实可行，用于注意缺陷多动障碍患儿行为问题的治疗有效。     

中文版注意缺陷多动障碍SNAP-Ⅳ评定量表-父母版的信效度

目的:引进中文版注意缺陷多动障碍SNAP-Ⅳ评定量表-父母版(Chinese version of Swanson Nolan and Pelham,VersionⅣScale-parent form,SNAP-Ⅳ)并检验其信效度.方法:对31名符合美国精神障碍诊断与统计手册第4版诊断标准的注意缺陷多动障碍(ADHD)门诊患儿和231名正常儿童进行中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版、中文版Conners父母用症状问卷(PSQ)及中文版Achenbach儿童行为量表(CBCL)评估,以检验校标效度.对27名受试者(ADHD组3人,正常组24人)1周内再次进行中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版评估,以检验重测信度.结果:中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版全量表内部一致性信度Cronbachα系数为0.95,注意力不集中、多动冲动、对立违抗3个分量表Cronbach α系数分别为0.90、0.89、0.88.重测信度组内相关系数(ICC)为0.68,3个分量表的重测信度ICC分别为0.75、0.76、0.24.中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版与PSQ及CBCL对应各因子得分之间相关系数分别介于0.29～0.73、0.30～0.74,验证性因子分析显示中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版的3因子及4因子模型均合理.中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版诊断ADHD敏感度为0.87,特异度为0.79.结论:中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版具有良好的信度与效度.     

注意缺陷多动障碍易感基因的定位与克隆研究进展

注意缺陷多动障碍易感基因的定位与克隆主要有候选基因克隆法和定位克隆法。本文系统 介绍了注意缺陷多动障碍易感基因定位克隆的研究现状和存在的问题以及解决的办法。     

注意缺陷多动障碍易感基因的定位与克隆研究进展

注意缺陷多动障碍易感基因的定位与克隆主要有候选基因克隆法和定位克隆法。本文系统介绍了注意缺陷多动障碍易感基因定位克隆的研究现状和存在的问题以及解决的办法。     

注意缺陷多动障碍与品行障碍共病机制的双生子研究

目的 研究遗传因素和环境因素的相互作用对于注意缺陷多动障碍和品行障碍共病的影响.方法 利用已经建立的西南地区双生子随访登记系统,采用定量行为遗传学研究方法,用《困难和长处量表》父母评定的注意缺陷多动和品行问题分量表分作为定量表型,收集140对6～16岁双生子的临床资料,构建双生子行为表型的单因素和二因素结构方程模型,分析变量内双生子间、变量间双生子内以及变量间双生子间的相关性,基于模型的似然值和拟合度寻找最优模型,阐明遗传因素、共享的环境因素以及非共享的环境因素对于注意缺陷多动障碍和品行障碍共病的影响.结果 注意缺陷多动和品行问题的表型相关性为0.44(95% CI:0.09～0.27),其中遗传因素在二者总的表型相关性中占70%,非共享的环境因素占30%.对相关变量构建二因素结构方程模型并进行多个模型拟合,对寻找出的最优模型分析发现,注意缺陷多动和品行问题遗传相关性为0.76(95% CI:0.31～1),而个体特异性环境相关性为0.28(95% CI:0.02～0.51).结论 儿童存在3种不同的遗传因素影响注意缺陷多动障碍和品行障碍的发生,即单纯影响注意缺陷多动障碍的遗传因素、单纯影响品行障碍的遗传因素和对二者同时发生作用的遗传因素.本研究结果提示大部分作用于注意缺陷多动障碍的环境因素不会导致品行障碍的发生,即二者缺乏共同的环境因素.     

注意缺陷多动障碍大学生注意分配能力

目的分析比较注意缺陷多动障碍（ADHD〉大学生和正常大学生的注意力分配情况,探讨ADHD大学生特殊的注意力分配机制。方法应用文德犹他成人ADHD评定量表筛选出实验组被试34人和对照组被试34人后,进行上机实验,同时完成按键反应和记忆数字双重任务,分析比较两组被试完成按键反应任务的反应时和记忆数字任务的正确率,并比较在80次任务中反应时的标准差。结果方差分析数据显示,在反应时上,注意缺陷多动障碍组显著长于正常对照组（t=4．504,P〈0．05）;在能体现反应变异性的标准差上,实验组也要显著高于对照组（F=18．143,P〈0．05）;但在回忆成绩的正确率上,两组并没有差异（t=0．465,P〉0．05）。结论ADHD患者注意分配能力确实存在一定缺陷,ADHD个体在完成同样的注意分配操作的前提下,需要花费更长时间,耗费更多资源,并且不能很稳定的进行注意资源分配。     

Concordance of actigraphy with polysomnography in children with and without attention‐deficit/hyperactivity disorder

This study sought to: (1) compare actigraphy‐derived estimated sleep variables to the same variables based on the gold‐standard of sleep assessment, polysomnography; (2) examine whether the correlations between the measures differ between children with attention‐deficit/hyperactivity disorder and typically developing children; and (3) determine whether these correlations are altered when children with attention‐deficit/hyperactivity disorder are treated with medication. Participants (24 attention‐deficit/hyperactivity disorder; 24 typically developing), aged 6–12 years, completed a 1‐week baseline assessment of typical sleep and daytime functioning. Following the baseline week, participants in the attention‐deficit/hyperactivity disorder group completed a 4‐week blinded randomized control trial of methylphenidate hydrochloride, including a 2‐week placebo and 2‐week methylphenidate hydrochloride treatment period. At the end of each observation (typically developing: baseline; attention‐deficit/hyperactivity disorder: baseline, placebo and methylphenidate hydrochloride treatment), all participants were invited to a sleep research laboratory, where overnight polysomnography and actigraphy were recorded concurrently. Findings from intra‐class correlations and Bland–Altman plots were consistent. Actigraphy was found to provide good estimates (e.g. intra‐class correlations >0.61) of polysomnography results for sleep duration for all groups and conditions, as well as for sleep‐onset latency and sleep efficiency for the typically developing group and attention‐deficit/hyperactivity disorder group while on medication, but not for the attention‐deficit/hyperactivity disorder group during baseline or placebo. Based on the Bland–Altman plots, actigraphy tended to underestimate for sleep duration (8.6–18.5 min), sleep efficiency (5.6–9.3%) and sleep‐onset latency, except for attention‐deficit/hyperactivity disorder during placebo in which actigraphy overestimated (?2.1 to 6.3 min). The results of the current study highlight the importance of utilizing a multimodal approach to sleep assessment in children with attention‐deficit/hyperactivity disorder.     

Contribution of ADHD characteristics to the academic treatment outcome of children with learning difficulties

This study analyzed how different characteristics of attention deficits are connected to academic treatment outcomes among children with learning difficulties belonging to either a neurocognitively oriented treatment group or a homework support treatment group. The academic treatment outcome of children showing attention deficit hyperactivity disorder (ADHD) symptoms was compared to the outcome of children with no ADHD symptoms. The connection of inattention, hyperactivity, and change in inattention and hyperactivity to academic treatment outcome was analyzed comparing children with no ADHD symptoms and children with ADHD symptoms. Children with ADHD symptoms improved equally well as children with no symptoms. Improvement of attention was associated with improvement in reading and writing, and initial hyperactivity was associated with improvement in mathematics. The findings suggest that hyperactivity and inattention are differentially associated with treatment outcome among children with ADHD symptoms. Based on the findings it seems that consideration of the dimensions (inattention and hyperactiv‐ity‐impulsivity) suggested by the Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) can give relevant information for treatment planning.     

Parent Stress and Coping in Relation to Child ADHD Severity and Associated Child Disruptive Behavior Problems

Examined parent role distress and coping in relation to childhood attention deficit hyperactivity disorder (ADHD) in mothers and fathers of 66 children age 7 to 11 (42 boys, 24 girls; mean age = 10.2). Parents of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children. Parents of ADHD combined and inattentive type children did not differ significantly in levels of distress. For mothers, child inattention and oppositional-conduct problems but not hyperactivity contributed uniquely to role distress (dissatisfaction related to parenting or parenting performance). For fathers, parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity. Parent coping by more use of positive reframing (thinking about problems as challenges that might be overcome) was associated with higher role satisfaction for both mothers and fathers. Community supports were associated with higher distress for mothers only.     

The Validity of Attention Deficit Hyperactivity and Hyperkinetic Disorder Symptom Domains in Nonclinical Dutch Children

Examined the validity of attention deficit hyperactivity disorder (ADHD) and hyperkinetic disorder (HKD) symptom domains in a sample of Dutch school children aged 10 to 14 years (N = 558). Confirmatory factor analysis indicated that symptoms of inattention, hyperactivity, and impulsivity were satisfactorily represented in various models. Psychopathological correlates of ADHD/HKD symptom domains were examined through their associations with the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). As expected, all three symptom domains were strongly associated with externalizing problems. Furthermore, inattention and hyperactivity were more strongly related to CBCL/YSR attention problems, whereas impulsivity was more strongly associated with symptoms of aggression and delinquency.     

Predictors of Response to Behavioral Treatments Among Children With ADHD-Inattentive Type

The goal of the study was to examine baseline characteristics—child gender, IQ, age, internalizing problems, symptoms of hyperactivity/impulsivity (HI), oppositional defiant disorder, and sluggish cognitive tempo, and parent income, education, attention deficit/hyperactivity disorder (ADHD) severity, and anxiety/depression (A/D)—associated with response to behavioral treatments for ADHD, predominantly inattentive type. We employed data from 148 children (M = 8.7 years), 58% male, and 57% Caucasian in a randomized clinical trial. Positive treatment response was defined as (a) 5 or fewer inattentive symptoms and (b) a decrease of at least 3 inattentive symptoms from baseline to posttreatment. Child HI, parental A/D, and child IQ were associated with positive response, as follows: Child HI had a main effect in which it was negatively associated with treatment response (36% with 2 or more HI symptoms were positive responders vs. 59% of those with 1 or no symptoms) that was qualified by parental A/D and child IQ. When children had 2 or more symptoms of HI and higher parental A/D, positive response rate was low at 25%; when children had 2 or more symptoms of HI, low parental A/D, and an IQ of 105 or higher, positive response rate was 85%. Furthermore, the group with the poorest response rate (25%) had parents who self-reported greater ADHD severity, and the group with a relatively good rate of positive response (59%) had the lowest number of oppositional defiant disorder symptoms. Likelihood of positive response to our behavioral treatment for ADHD-I is dependent on child and parent factors.     

Differentiating Between Comorbidity and Symptom Overlap in ADHD and Early Onset Bipolar Disorder

Reported rates of comorbidity between early onset bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) have a wide range, perhaps due to developmental issues and differences in interpretation of overlapping symptoms. We compared questionnaire-based and neuropsychological measures of inattention and impulsivity/hyperactivity, in children/adolescents with ADHD combined subtype (ADHD-C; n26), concurrent ADHD-C and BD (n15), BD (n25) with Controls (n69). Sub-analyses were performed on BD with and without inattention symptoms. The two ADHD-C groups displayed neuropsychological impairments that were not found in the BD group in spite of subjective and questionnaire-rated inattention. The findings caution against over-diagnosis of ADHD in BD.     

The Protective Effects of Social Factors on the Academic Functioning of Adolescents With ADHD

There is considerable evidence that externalizing disorders such as attention deficit/hyperactivity disorder (ADHD) put youth at risk for a range of adverse academic outcomes. It is importantly to note that some youth avoid these negative outcomes, yet there is a gap in our understanding of these resilient youth. The purpose of this study was to longitudinally evaluate social acceptance and social skills as potential protective factors of the associations between inattentive, hyperactive/impulsive, and oppositional defiant behaviors with academic outcomes. Participants included a sample of 93 middle school students comprehensively diagnosed with ADHD. Parents and adolescents completed ratings of social skills and perceived social acceptance. School grades and teacher-rated academic impairment were assessed 18 months later as longitudinal academic functioning outcomes. Inattention and social acceptance were associated with academic outcomes 18 months later. Regression analyses revealed that parent- and adolescent-rated social acceptance demonstrated promotive effects for grades and against teacher-rated academic impairment. Further, social acceptance significantly interacted with inattention in predicting school grades, such that high parent- and adolescent-rated social acceptance significantly attenuated the relationship between inattention and poor grades, even after controlling for baseline grades and intelligence. The presence of social acceptance was especially critical for adolescents with high levels of inattention. Specifically, adolescents with high inattention and high social acceptance had a mean grade point average of 2.5, and adolescents with high inattention and low social acceptance had a mean grade point average of 1.5. These findings demonstrate that social acceptance may be an important intervention target for improving academic outcomes among adolescents with ADHD.     

The relation between working memory components and ADHD symptoms from a developmental perspective

The objective was to examine the relations between attention deficit hyperactivity disorder (ADHD) symptoms and four working memory (WM) components (short-term memory and central executive in verbal and visuospatial domains) in 284 6-16-year-old children from the general population. The results showed that verbal and visuospatial short-term memory and verbal central executive uniquely contributed to inattention symptoms. Age interacted with verbal short-term memory in predicting inattention, with the relation being stronger in older children. These findings support the notion of ADHD as a developmental disorder, with changes in associated neuropsychological deficits across time. The results further indicate ADHD-related deficits in several specific WM components.     

The impact of daytime sleepiness on the school performance of college students with attention deficit hyperactivity disorder (ADHD): a prospective longitudinal study

This prospective longitudinal study evaluated the impact of daytime sleepiness on the school performance of 62 college students diagnosed comprehensively with attention deficit hyperactivity disorder. The primary goal of the study was to determine if self‐reported daytime sleepiness rated at the beginning of the academic year could predict academic and overall functioning at the end of the academic year while also considering potentially important covariates, including symptoms of inattention, hyperactivity and impulsivity, medication status and whether or not students lived at home or on‐campus. Self‐reported daytime sleepiness predicted longitudinally school maladjustment, overall functional impairment and the number of D and F grades (i.e. poor and failing) students received in courses above and beyond both self‐ and parent‐report of symptoms, but did not predict overall grade point average. Living at home served as a protective factor and was associated with less school maladjustment and overall impairment. Gender was the only significant predictor in the overall grade point average model, with female gender associated with higher overall grades. The implications of these findings for monitoring and treatment of sleep disturbances in college students with attention deficit hyperactivity disorder are discussed.     

Outcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity

Despite the early onset of attention deficit disorder with hyperactivity (ADDH), there is a dearth of treatment studies with preschoolers with this disorder. Forty-six families with ADDH preschoolers were randomly assigned to either an immediate or a delayed group parent training program aimed at improving child compliance. Groups were balanced on demographic variables. Treatment outcome was evaluated by comparing the groups at pre- and posttreatment and 3-month follow-up on measures of parent-child interactions during free play, a compliance task, and parent-supervised activities, as well as on parent-completed Conners Hyperkinesis Index scores. Positive treatment effect was obtained on measures of compliance, parental style of interaction, and management skills. These improvements were maintained at 3-month follow-up. Evaluation of treatment effects on nontargeted child behaviors indicated no generalization.