儿童注射缺陷多动障碍DSM—Ⅳ亚型的临床特比比较研究

目的：比较DSM－Ⅳ注意缺陷多动障碍（AD／HD）以注意障碍为主型（PI）、以多动／冲动为主型（HI）和混合型（CT）的临床特征，方法：将门诊儿童符合DSM－ⅣADHD诊断标准者126例分为PI型61例；HI型9例、CT型56例，比较三型合并障碍的诊断、父母、教师量表评分；韦氏儿童智力检测（C－WISC）和注意测验。结果：CT组合并品行障碍的发生率，父母，教师评定违纪行为和攻击性行为分量表、外向性行为问题及行问题显著高于PI组。WISC填图，划销测验净分低于PI组。教师评定学校情况PI组优于HI组和CT组。结论：ADHD混合型的外向性行为问题。学业问题，注意力缺陷最严重，注意障碍为主型则在各方面损害较轻。     

注意缺陷多动障碍儿童行为问题的对照研究

目的：比较注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder，ADHD）临床亚型和正常儿童的行为问题。方法：将符合DSM—Ⅳ ADHD诊断标准的男童70例分为注意障碍为主型（PI）44例，以多动／冲动为主型（HI）6例、混合型（CT）20例，采用儿童行为量表（Child Behavior Checklist，CBCL）比较各亚型和正常儿童的行为问题。结果：ADHD组行为问题发生率（48．57％）明显高于对照组（12．70％），P〈0．01；ADHD各亚型行为问题发生率存在统计学差异（P〈0．01）。混合型最高；ADHD亚型与对照组CBCL因子分的4组间比较显示分裂性、强迫性、体诉、多动、攻击性、违纪因子及CBCL总分存在统计学差异；分裂性因子PI〉HI，攻击性因子CT，HI〉PI，违纪因子HI〉PI，CT。结论：ADHD男童行为问题发生率高于正常儿童，其中混合型行为问题发生率最高；ADHD临床亚型行为问题特点不同。     

不同亚型注意缺陷多动障碍儿童智力特征的分析

目的：探讨不同亚型注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）儿童的智力特征的差异。方法：根据美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）对广州市初诊ADHD患儿进行诊断和临床分型，其中注意缺陷为主型（predominantly inattentive type，I）42例、多动-冲动为主型（predominantly hyperactive impulsive type，HI）11例、混合型（combined type，C）53例，对3组患儿使用韦氏儿童智力量表进行智力测试，并对三组的智力测试结果VIQ、PIQ、FIQ进行分析比较。结果：三个亚型患儿之间FIQ和VIQ比较无明显差异（P〉0．05），注意缺陷为主型VIQ明显低于混合型（P〈0．05），其余两两比较无差异。注意缺陷为主型患儿中VIQ比PIQ差值大于15者比例最高（83．33％），多动冲动为主型和混合型中为18．18％，28．30％，同时PIQ比VIQ差值大于15者各为27.27％，20.75％。结论：不同亚型ADHD患儿的智力分布存在一定的差别，注意缺陷为主型与另两种亚型有不同的智力结构。     

整合视听连续执行测试与儿童感觉统合能力的相关性分析

目的：通过整合视听连续执行测试和儿童感觉统合能力评定，探讨二者之间的相关性及各亚型ADHD儿童的感觉统合能力的差异。方法：根据整合视听连续执行测试结果将170名儿童分成4组，对各组儿童进行感觉统合能力评定。结果：注意缺陷为主型儿童的视觉反应控制商数与本体感及身体协调因子分呈负相关；多动-冲动为主型儿童的综合尺度反应控制商数、视觉反应控制商数、综合尺度注意力商数、听觉注意力商数与学习能力发展因子分呈正相关；混合型儿童的综合尺度注意力商数、视觉注意力商数与学习能力发展因子分呈正相关；注意缺陷为主型和混合型儿童的大肌肉及平衡感、学习能力发展因子分低于临界值；多动-冲动为主型儿童的学习能力发展因子分低于临界值．触觉防御及情绪因子分高于临界值；其他各项因子分接近临界值。结论：根据整合视听连续执行测试结果诊断的ADHD各亚型的综合商数与感觉统合能力发展评定量表因子分的相关性是不同的；各亚型ADHD儿童的感觉统合能力均较低，且都存在着学习能力发展不足问题；注意缺陷为主型和混合型儿童的大肌肉及平衡感失调比多动-冲动为主型儿童更明显。     

注意缺陷多动障碍儿童认知功能的对照研究

目的：探讨注意缺陷多动障碍各亚型的认知功能。方法：对113名8—12岁注意缺陷多动障碍男童与83名正常儿童采用威斯康星卡片分类测验进行对照研究。结果：ADHD各型儿童的分类次数和概括力水平均低于对照组，并以混合型最低，而注意冲动型与混合型的持续性反应与持续性错误均明显高于对照组。在控制智力因素后，仍存在显著性差异。在ADHD各亚型间，以混合型最明显，其次为注意障碍型，三型之间除非持续性错误外。主要指标比较无显著性差异。结论：ADHD儿童存在认知功能损害，且不同亚型之间的损害程度不同。     

注意缺陷多动障碍的遗传学和认知内表型研究概况(综述)

注意缺陷多动障碍（Attention Deftcit Hyperactivity Disorder，ADHD）是儿童期常见、早期发生的认知、行为发展性的精神障碍，其主要特征为与年龄不相称的注意力不集中、多动和冲动行为。学龄期儿童患病率为4-12％．男女比例为3～9：1，其中50％～80％可持续至青年，30％-50％持续到成年。美国精神疾病诊断和统计手册第四版（DSM—IV）将其分为注意缺陷为主型、多动一冲动为主型和混合型三种亚型。ADHD是由遗传学、生物学、环境和家庭压力共同作用形成的一种多基因遗传性疾病。本文根据ADHD的遗传学研究及认知理论模型，综述其可能的认知内表型研究。     

儿童注意缺陷多动障碍脑电生物反馈训练疗效的对照研究

目的:研究脑电生物反馈训练治疗儿童注意缺陷多动障碍(ADHD)的效果。方法:利用美国ProComp+/Bio-Graph脑电生物反馈系统治疗儿童ADHD,每次30分钟,每周2次,共计40次,并采用视听整合连续性行为测试(I-VA-CPT)作为脑电生物反馈训练疗效的评定方法。结果:在60例ADHD儿童中,以注意缺陷为主型综合注意力商数为70.10±11.79,以多动冲动为主型综合反应控制商数为75.10±10.98,混合型综合注意力商数和综合反应控制商数分别为58.05±16.53和68.90±11.47。经脑电生物反馈训练治疗后,儿童ADHD以注意缺陷为主型、以多动冲动为主型和混合型IVA-CPT指标均显著提高(P<0.001)。结论:脑电生物反馈训练是一种治疗儿童ADHD的有效措施。     

学龄前注意缺陷多动障碍儿童的视觉-运动整合能力

目的:探讨学龄前注意缺陷多动障碍(ADHD)儿童的视觉-运动整合能力特点,为实施有针对性的早期干预方案提供依据.方法:采用1∶1病例对照的设计,选取符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ) ADHD诊断标准的4～6岁儿童(混合型37例、注意缺陷为主型28例、多动/冲动为主型14例)及正常对照各79例.采用视觉-运动整合发育测验(VMI)来评定视觉-运动整合情况.结果:ADHD儿童VMI测验异常检出率高于对照组(32.9％ vs.7.6％,P＜0.01);ADHD各亚型VMI测验异常检出率从高到低依次为混合型、注意缺陷为主型、多动/冲动为主型,各亚型组间差异均有统计学意义(45.9％ vs.25.0％ vs.14.3％,均P＜0.05);ADHD儿童的VMI测验得分低于正常对照组[(90.2±19.4) vs.(100.5±10.7),P＜0.05],混合型ADHD儿童的VMI测验得分低于注意缺陷为主型和多动/冲动为主型[(84.5±23.1) vs.(93.7±15.2),(97.9±11.5);均P＜0.05].结论:学龄前ADHD儿童可能存在视觉-运动整合能力方面的缺陷,对学龄前ADHD儿童视觉-运动整合能力的评估有助于早期识别和早期预防学习和行为问题.     

儿童注意缺陷多动障碍DSM-Ⅳ亚型的临床特征比较研究*

目的:比较DSM-Ⅳ注意缺陷多动障碍(AD/HD)以注意障碍为主型(PI)、以多动/冲动为主型(HI)和混合型(CT)的临床特征.方法:将门诊儿童符合DSM-ⅣADHD诊断标准者126例分为PI型61例;HI型9例、CT型56例,比较三型合并障碍的诊断,父母、教师量表评分;韦氏儿童智力测验(C-WISC)和注意测验.结果:CT组合并品行障碍的发生率,父母、教师评定违纪行为和攻击性行为分量表、外向性行为问题及行为问题均显著高于PI组,WISC填图、划销测验净分低于PI组.教师评定学校情况PI组优于HI组和CT组.结论:ADHD混合型的外向性行为问题、学业问题、注意力缺陷最严重,注意障碍为主型则在各方面损害较轻.     

注意缺陷多动障碍儿童相同图形选择测验的对照研究

目的 :了解相同图形选择测验在注意缺陷多动障碍儿童中的应用。方法 :对符合DSM -Ⅳ注意缺陷多动障碍的 113名儿童与 83名正常对照儿童用自编的相同图形选择测验进行对照研究 ,并进行多元逐步判别分析。结果 :ADHD混合型和多动冲动为主型儿童的平均错误次数明显多于正常对照组 ,而第一次平均选择的反应时间较对照组少 ,混合型儿童的平均选对时间较对照组短 ,逐步判别分析发现判别正确率66 8%。结论 :相同图形选择测验可作为ADHD儿童冲动控制障碍的辅助评定工具。     

不同亚型注意缺损多动障碍（ADHD）患儿智力结构分析

目的分析不同亚型多动症儿童的智力结构特征,探索不同亚型多动症儿童认知缺损发生机制,为多动症的临床诊断和治疗提供参考。方法随机抽取注意缺陷型、多动冲动型和混合型多动症儿童各60例,从学校抽取100例正常儿童作为对照,均采用中国韦氏儿童智力量表（c-WISC）进行智力测验,对各类儿童进行智力结构分析。结果多动症儿童韦氏总智商低于正常儿童（P〈0.01）,且智商变异性大,PIQ与VIQ不平衡发生率高于正常儿童;注意缺陷型言语智商高于多动冲动型和混合型（P〈0.01）,多动冲动型操作智商高于注意缺陷型（P〈0.01）,但和混合型无差异,混合型总智商低于其它两种亚型。结论多动症儿童智力受损是客观事实,不同多动症亚型智力结构和缺损程度存在差异,提示多动冲动型和注意缺陷型认知机制不完全相同,应对多动症患儿进行区别诊断和针对性治疗。     

注意缺陷多动障碍儿童整合视听连续执行测验的比较研究

目的 :探讨整合视听连续执行测验对注意缺陷多动障碍儿童 (ADHD)的评定价值及特征。方法 :对 5 1例不伴成绩不良的ADHD儿童及 2 4例伴成绩不良的ADHD儿童采用整合型视听连续执行测验并比较两组的测验结果。结果 :伴有成绩不良的ADHD儿童的听觉及反应控制商、听觉审慎性、一致性、听、视觉注意商、警觉性、集中度均低于不伴成绩不良组 ,但无显著性差异。结论 :ADHD儿童存在反应控制能力和注意能力的损害 ,IVA -CPT可作为神经心理测验评定工具。     

Response Inhibition and Attention Deficit Hyperactivity Disorder With and Without Oppositional Defiant Disorder Screened From a Community Sample

The study compared performance of children with high levels of attention deficit hyperactivity disorder (ADHD; n = 22), children with ADHD and oppositional defiant disorder (ODD; n = 19), and a control group (n = 20) on a Go-No-go test in a self-paced and computer-paced condition. Each condition, in turn, was run in a reward and a nonreward condition. The children were recruited through screening of a school population without ADHD or ODD (N = 450). Findings indicated that children having high levels of ADHD plus ODD showed poor impulse control in all 4 conditions. No poor impulse control was found in the group with high levels of ADHD. This group demonstrated slower RTs across the computer-paced conditions. Findings were discussed in terms of the response-inhibition hypothesis, as formulated by Barkley (1997), the delay-aversion theory (Sonuga-Barke, 1995), and the state-regulation theory (Van der Meere, 2002).     

An investigation of visuospatial memory impairment in children with attention deficit hyperactivity disorder (ADHD), combined type

BACKGROUND: Memory impairment is not considered a core cognitive feature of attention deficit hyperactivity disorder, combined type (ADHD-CT), although it is associated with impairments in attentional and executive functions. This study investigates visuospatial memory impairment, in particular encoding and retrieval aspects, in children with ADHD-CT who are stimulant-medication naive and medicated with stimulant medication. METHOD: A cross-sectional study of visuospatial memory in 6- to 12-year-old children with stimulant-medication-naive ADHD-CT (n = 62) and medicated ADHD-CT (n = 58) compared to an age- and gender-matched healthy control group (n = 39) was completed. RESULTS: Both medication-naive and medicated ADHD-CT groups demonstrated subtle yet significant impairment in visuospatial memory. The memory impairment was delay-independent, which, along with other factors, suggest dysfunction of the encoding rather than retrieval phase of visuospatial memory. CONCLUSIONS: Careful study of large ADHD-CT samples does detect deficits in a visuospatial memory task, but these reflect attentional deficits rather than being specifically due to dysfunction of the medial temporal lobe explicit memory system. Children with ADHD-CT may benefit from cognitive and behavioural strategies focused on improving encoding of relevant information rather than retrieval strategies.     

Snoring, sleep quality, and sleepiness across attention-deficit/hyperactivity disorder subtypes

STUDY OBJECTIVES: To characterize the relationship between pediatric attention-deficit/hyperactivity disorder (ADHD) subtypes, chronic snoring, and indexes of sleep quality and daytime sleepiness. DESIGN: A cross-sectional design with planned comparisons of ADHD (all subtypes) versus general community controls; ADHD Predominantly Inattentive Type (ADHD-I) versus a group with both ADHD Predominantly Hyperactive/Impulsive Type (ADHD-HI) and ADHD Combined Type (ADHD-C); and ADHD-HI versus ADHD-C. SETTING: Subjects recruited from a pediatric clinic, a university psycholgy clinic, and the general community. PARTICIPANTS: Caretakers of 74 children (45 with ADHD, 29 community controls; 53 boys, 21 girls; mean age, 9.6 years; age range, 6 to 16 years). Thirty-two (71.1%) of the children with ADHD were taking stimulant medication and 7 (15.5%) were taking hypnotic medication. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Caretakers completed the Pediatric Sleep Questionnaire (PSQ) and the Children's Sleep-Wake Scale (CSWS). Only the ADHD-HI diagnosis was associated with an increased likelihood of chronic snoring. Sleep quality was poorer among children with ADHD than controls; however, there were no differences in sleep quality across ADHD subtypes. Sleepiness was greater in children with ADHD, especially the ADHD-I Type. CONCLUSIONS: Chronic snoring may be a correlated feature in only a subgroup of the ADHD population, possibly those more likely to be diagnosed with ADHD-HI. Although children with ADHD have poorer sleep quality and greater daytime sleepiness, these 2 features of ADHD are not closely related.     

注意缺陷多动障碍儿童记忆和学习的研究

目的：探讨注意缺陷多动障碍DSM－Ⅳ亚型记忆学习功能及与持续性注意的关系。方法：对113名8－12岁注意缺陷我动障碍男童与83名正常儿童对照研究，并与持续性注意测验进行相关分析。结果：ADHD各亚型图案记忆成绩均较对照组差；混合型儿童的图片记忆，言语记忆和故事记忆成绩较对照组差。持续性注意测验的击中度，虚报数，d‘值与记忆和学习相关。结论：注意缺陷多动障碍儿童存在记忆与学习功能损害，与注意障碍明显相关。     

Assessing attentional systems in children with Attention Deficit Hyperactivity Disorder

The aim of this study was to evaluate the efficiency and interactions of attentional systems in children with Attention Deficit Hyperactivity Disorder (ADHD) by considering the effects of reinforcement and auditory warning on each component of attention. Thirty-six drug-na?ve children (18 children with ADHD/18 typically developing children) performed two revised versions of the Attentional Network Test, which assess the efficiency of alerting, orienting, and executive systems. In feedback trials, children received feedback about their accuracy, whereas in the no-feedback trials, feedback was not given. In both conditions, children with ADHD performed more slowly than did typically developing children. They also showed impairments in the ability to disengage attention and in executive functioning, which improved when alertness was increased by administering the auditory warning. The performance of the attentional networks appeared to be modulated by the absence or the presence of reinforcement. We suggest that the observed executive system deficit in children with ADHD could depend on their low level of arousal rather than being an independent disorder.     

Dysthymic disorder contributes to oppositional defiant behaviour in children with Attention Deficit Hyperactivity Disorder, combined type (ADHD-CT)

BACKGROUND: The specific relationships between oppositional defiant disorder (ODD), ADHD-CT, dysthymic disorder (DD) and anxiety disorders symptoms have not been studied in children with ADHD-CT. The relationship to DD is important because DD is common, has an earlier age of onset, is associated with significant morbidity and with increased rates of treatment non-responsiveness when comorbid with major depressive disorder and/or ADHD-CT. METHODS: 200 clinically referred children with ADHD-CT, without comorbid major depressive disorder, were identified. "ODD", "ADHD-CT", "DD" and "anxiety disorders" symptoms were defined by composite measures of (1) semi-structured clinical interview and (2) parent and/or child standardized questionnaires. Standard multiple regression was used to examine how well "ADHD-CT", "DD" and "anxiety disorders" symptoms predict "ODD" symptoms. RESULTS: Only "ADHD-CT" (15% of the variance) and "DD" (8% of the variance) symptoms made independent significant contributions to the prediction of "ODD" symptoms. LIMITATIONS: The study's sample size did not allow "ODD" and "conduct disorder" symptoms to be analysed separately. CONCLUSIONS: The association of DD with ODD may reflect a unique contribution of DD to ODD in children, whether ADHD-CT is present or not, or only when ADHD-CT is present.     

Peer-Assessed Outcomes in the Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder

Peer-assessed outcomes were examined at the end of treatment (14 months after study entry) for 285 children (226 boys, 59 girls) with attention deficit hyperactivity disorder (ADHD) who were rated by their classmates (2,232 classmates total) using peer sociometric procedures. All children with ADHD were participants in the Multimodal Treatment Study of Children with ADHD (MTA). Treatment groups were compared using the orthogonal treatment contrasts that accounted for the largest amount of variance in prior MTA outcome analyses: Medication Management + Combined Treatment versus Behavior Therapy + Community Care; Medication Management versus Combined Treatment; Behavior Therapy versus Community Care. There was little evidence of superiority of any of the treatments for the peer-assessed outcomes studied, although the limited evidence that emerged favored treatments involving medication management. Post hoc analyses were used to examine whether any of the four treatment groups yielded normalized peer relationships relative to randomly selected-classmates. Results indicated that children from all groups remained significantly impaired in their peer relationships.     

Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders.

Some previous studies have reported the involvement of magnesium (Mg) deficiency in children with ADHD syndrome. In this work, 40 children with clinical symptoms of ADHD were followed clinically and biologically during a magnesium-vitamin B6 (Mg-B6) regimen (6 mg/kg/d Mg, 0.6 mg/kg/d vit-B6) which was set up for at least 8 weeks. Symptoms of ADHD (hyperactivity, hyperemotivity/ aggressiveness, lack of attention at school) were scored (0-4) at different times; in parallel, intraerythrocyte Mg2+ (Erc-Mg) and blood ionized Ca2+ (i-Ca) were measured. Children from the ADHD group showed significantly lower Erc-Mg values than control children (n = 36). In almost all cases of ADHD, Mg-B6 regimen for at least two months significantly modified the clinical symptoms of the disease: namely, hyperactivity and hyperemotivity/aggressiveness were reduced, school attention was improved. In parallel, the Mg-B6 regimen led to a significant increase in Erc-Mg values. When the Mg-B6 treatment was stopped, clinical symptoms of the disease reappeared in few weeks together with a decrease in Erc-Mg values. This study brings additional information about the therapeutic role of a Mg-B6 regimen in children with ADHD symptoms.