注意缺陷多动障碍儿童事件相关电位P300特征分析

目的:探讨注意缺陷多动障碍(ADHD)儿童事件相关电位(event related potential,ERP)P300的特点。方法:对100例ADHD患儿(研究组)[注意缺陷为主型(ADHD-I)34例、多动/冲动为主型(ADHD-HI)24例、混合型(ADHD-C)42例)]和100名正常儿童(对照组)前额区(Fz)、中央区(Cz)两个脑区的ERP P300潜伏期及波幅进行检测,比较分析研究组与对照组、ADHD各亚型及不同SNAP-Ⅳ评分分组(1.6~2.0为中度组、2.0为重度组)的P300潜伏期及波幅的差异。结果:1与对照组比较,研究组靶刺激在前额区(Fz)及中央区(Cz)P300潜伏期显著延长,波幅降低,差异具有统计学意义(P均0.01);2ADHD各亚型组间P300潜伏期与波幅差异无统计学意义(P0.05);3不同SNAP-IV评分组间,P300潜伏期与波幅差异无统计学意义(P0.05)。结论:ADHD患儿P300的潜伏期显著延长,波幅降低,提示ADHD患儿对信息加工处理的速度减慢,注意力、记忆力缺陷及认知加工能力不足。     

注意缺陷多动障碍与血清铁蛋白、血铅水平的相关性分析

目的测定不同亚型的注意力缺陷多动障碍（ADHD）患儿血清铁蛋白（SF）、Hb、血铅水平,探讨其在ADHD发病中的变化及临床意义。方法采用《美国精神病学会精神障碍分类法》第4版（DSM-IV）ADHD临床诊断和分型标准,并结合Conner’s量表和视听整和连续执行测试法进行诊断,选择2008-01~2009-12本院儿科门诊确诊为ADHD的患儿115例。其中注意力缺陷型45例,混合型38例,多动-冲动型32例,同期选择本院行体检的健康儿童40例作为健康对照组。抽取清晨空腹静脉血行Hb、SF及血铅水平测定,应用SPSS11.0软件对其进行统计学分析。结果 （1）ADHD患儿各亚组SF水平均低于健康对照组,差异均有统计学意义（P〈0.05）,其中注意力缺陷型亚组SF水平下降明显,均低于混合型和多动-冲动型亚组（P〈0.05）。（2）ADHD患儿各亚组间血铅水平差异无统计学意义;各亚组与健康对照组比较,血铅水平差异亦均无统计学意义（P〉0.05）。（3）ADHD患儿各亚组间Hb水平差异无统计学意义;各亚组与健康对照组比较,Hb水平差异亦均无统计学意义（P〉0.05）。结论 ADHD尤其是注意力缺陷型患儿的发病可能与低水平SF有关,在诊治此类型患儿时应常规检测SF,并及早纠正。     

不同亚型注意缺陷多动障碍男童自我意识和行为问题特征研究

目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)男性患儿中注意缺陷型(predominantly inattentive type,PI)、多动/冲动型(predominantly hyperactive/impulsive type,HI)和混合型(combined type,CT)自我意识和行为问题的特征,以及两者关系。方法对68例8~11岁ADHD儿童(PI 31例,HI 12例,CT 25例)和70名正常儿童采用Piers-Harris儿童自我意识量表(the Piers-Harris children’s self-concept scale,PHCSS)、Achenbach儿童行为量表(Achenbach child behavior checklist,CBCL)进行评估。结果 PHCSS中,三亚型组总分和因子分均低于对照组(P0.01),PI组ADHD患儿自我意识总分高于HI组和CT组(P0.05),PI组躯体与外貌属性因子分和幸福与满足因子分高于HI组和CT组(P0.05),智力与学校情况因子分HI组低于PI组和CT组(P0.05)。CBCL中,三亚型ADHD患儿与对照组的总分及抑郁性、多动、攻击性、违纪因子分的差异均有统计学意义(P0.01),交往不良因子分HI组高于PI组(P0.01),社交退缩因子分HI组高于PI组(P0.01)。ADHD患儿自我意识总分与CBCL总分(r=-0.64)、抑郁(r=-0.47)、交往不良(r=-0.50)、社交退缩(r=-0.12)、多动(r=-0.66)、攻击性(r=-0.41)均呈负相关(P0.05)。结论不同亚型ADHD患儿行为问题均较正常儿童多,与其自我意识水平偏低关系密切。多动冲动型和混合型较注意缺陷型自我意识水平低,行为问题更突出。     

注意缺陷多动障碍患者的短时记忆和执行功能研究

目的评估注意缺陷多动障碍（ADHD）的记忆和执行功能。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90例正常儿童和90例ADHD儿童进行检测。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与正常组比较具有统计学差异;ADHD组中的三个亚型（多功-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个亚型有显著性差异外,其他项目评分比较无显著性差异。结论ADHD存在短时记忆和执行功能损害。     

儿童注意缺陷多动障碍的记忆和执行功能研究

目的：评估注意缺陷多动障碍（ADHD）的记忆和执行功能。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儿童进行检测。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与正常组比较具有统计学差异；ADHD组中的三个亚型（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它二型有显著性差异外，其它项目评分比较无显著性差异。结论：ADHD存在短时记忆和执行功能损害。     

注意缺陷多动障碍不同亚型患者的脑皮质结构特征分析

目的:探讨不同亚型注意缺陷多动障碍（attention deficit hyperactivity disorder,ADHD）儿童的脑皮质结构特征差异。方法:从美国儿童心理研究所健康大脑网络项目中获得412例样本数据,包括ADHD患儿288例（ADHD组）,其中混合型151例（ADHD-C组）、多动冲动型20例（AD...     

注意缺陷多动障碍患儿家庭环境因素分析

目的:探讨注意缺陷多动障碍(ADHD)患儿家庭环境因素。方法:应用家庭亲密度与适应性量表(FACES)及自制家庭环境因素调查表对60例ADHD儿童(ADHD组)及与其人口学资料相匹配的200名健康儿童(正常对照组)进行调查和比较。结果:ADHD组FACES中亲密性及适应性得分明显低于正常对照组(t=3.866,P=0.000;t=2.274,P=0.038);ADHD组母孕期情绪异常、父母有类似ADHD症状、教育方式不当、家庭经济条件差比率明显高于正常对照组(P均0.05)。Logistic回归分析显示社会经济地位、教养方式、母亲类似症状、父亲类似症状4个因素是儿童ADHD的危险因素。结论:家庭环境可能在ADHD发病中有明显作用。     

常规康复训练联合游戏治疗对孤独症谱系障碍共患注意缺陷多动障碍患儿的作用

目的:探讨常规康复训练联合游戏治疗对孤独症谱系障碍(ASD)共患注意缺陷多动障碍(ADHD)患儿的作用。方法:将60例ASD共患ADHD患儿随机分成观察组和对照组,两组在进行常规康复训练的基础上,给予观察组联合游戏治疗;疗程均为3个月。治疗前后应用孤独症治疗评估量表(ATEC)、ADHD筛查量表(SNAP-IV)对两组进行评估和比较。结果:治疗前两组间ATEC、SNAP-IV评分比较差异无统计学意义;治疗后两组ATEC、SNAP-IV评分显著降低(P均0.05);且观察组ATEC中表达/语言沟通及行为维度评分明显低于对照组(P均0.05);SNAP-IV总分、注意缺陷、多动/冲动及对立违拗各项评分明显低于对照组(P均0.05)。结论:常规康复训练联合游戏治疗对ASD共患ADHD患儿症状改善作用更优。     

鲁北地区4～16岁学生注意缺陷多动障碍患病情况及其家庭环境调查

目的 了解鲁北地区低龄人群注意缺陷多动障碍(ADHD)的流行情况,并分析其家庭环境特征.方法 应用问卷调查和专科访淡相结合的方法 ,采用自制的注意力及多动问题量表和家庭环境量表-中文版(FES-CV)调查分层随机整群抽样的4～16岁学生8235名,ADHD的诊断依照美国精神障碍诊断和统计手册第四版(DSM-Ⅳ).家庭环境调查时选择550名与ADHD学生性别、年龄、班级、家庭经济状况相匹配的健康学生为对照组.结果 ①患病率:ADHD总患病率为6.3%(515/8235),其中男性患病率高于女性(8.1%vs 4.4%,P＜0.001);6～11岁组患病率高于4～5岁组(7.7%vs 6.1%,P=0.02)和12～16岁(7.7%vs 5.3%,P=0.002);②亚型分布:ADHD-1是4～16岁人群ADHD的主要类型,占56.3%;不同年龄组ADHD亚型分布差异有统计学意义(P＜0.001),高年龄组ADHD-1比例增加;4～5岁组不同性别的亚型分布差异有统计学意义(P＜0.001),男性以ADHD-HI为主,女性以ADHD-Ⅰ为主,6～11岁组、12～16岁组亚型分布的性别差异均无统计学意义(P＞0.05);③家庭环境:ADHD组FES-CV量表的亲密度、情感表达、知识性、道德宗教观、组织性分值低于正常组(P＜0.001),娱乐性和矛盾性分值高于正常组(P＜0.001).结论 6～11岁人群和男性的ADHD患病率较高,年龄和性别对亚型分布有影响,注意力缺陷是ADHD核心症状;ADHD患者的家庭环境差.     

癫痫儿童合并注意缺陷-多动障碍的治疗进展

注意缺陷/多动障碍(attention-deficit hyperactivity disorder,ADHD)是指一种以注意缺陷、多动、冲动的行为表现为主要特征的精神病理障碍.目前将ADHD分注意缺陷型、多动-冲动型和混合型,癫痫合并ADHD的发病率普遍高于正常儿童,约为正常儿童的2.5倍[1].国外流行病学资料显示:ADHD在癫痫儿童中的检出率为12%～39%;其中注意缺陷型(ADHD-I)占24%,多动/冲动型(ADHD-HI)占2%,而混合型(ADHD-C)占11% [2].同时ADHD在癫痫发作中和控制良好中的检出率又有很大差异,前者为31%,而后者为6%[3].癫痫合并ADHD的发病机制尚不明确,诊断标准及治疗仍未达成共识.     

高三学生考试焦虑与家庭亲密度和适应性的研究

目的探讨高三学生考试焦虑状况及与家庭亲密度和适应性之间的关系。方法采用整群抽样方法抽取合肥市3所高级中学中参加2013年高考的应届高三学生334人,应用状态-特质焦虑问卷(STAI)、症状自评量表(SCL-90)、家庭亲密度和适应性量表中文版(FACESⅡ-CV)进行调查。结果是否是独生子女以及不同性别之间在焦虑状态、焦虑特质、亲密度及适应性评分差异均无统计学意义(P0.05);亲密度和躯体化、强迫、焦虑状态和焦虑特质呈负相关(r=-0.314~-0.143,P0.01);适应性和焦虑状态、焦虑特质呈负相关(r=-0.265~-0.214,P0.01)。结论良好的家庭亲密度和适应性有利于减轻高三学生的考试焦虑。     

Does actigraphy differentiate ADHD subtypes in a clinical research setting?

OBJECTIVE: To compare subtypes of attention-deficit/hyperactivity disorder (ADHD) (predominantly inattentive and combined types) and a comparison group on an objective measure of activity level (actigraphy). METHOD: Actigraphs were worn by 64 children (49 boys, 15 girls) during a full-day clinical diagnostic assessment; 20 subjects had a diagnosis of ADHD predominantly inattentive type, 22 had ADHD combined type, and 22 were non-ADHD controls. Mean actigraph scores were calculated for two 2-hour intervals, comprising, respectively, a psychometric evaluation in the morning and the completion of a speech and language assessment and research measures in the afternoon. RESULTS: There were no significant group differences in activity level in the morning session. During the afternoon session, children with ADHD were significantly more active than controls, but there were no differences between ADHD subtypes. CONCLUSIONS: These data partially support specifications in the DSM-IV regarding hyperactivity in ADHD; however, they also indicate that situational and/or temporal factors may affect the degree to which hyperactivity is expressed. Furthermore, the findings contradict specifications in the DSM-IV that suggest that children with ADHD combined type should be more hyperactive than children with ADHD predominantly inattentive type.     

Attention and executive functions profile in drug naive ADHD subtypes

Attention deficit hyperactivity disorder (ADHD) has been associated with executive functioning and sustained and divided attention deficits. In order to clarify the questions on neurocognitive impairment in ADHD, we investigated the presence of specific executive functions (EFs) and attention deficit patterns in ADHD clinical subtypes. 50 patients with ADHD and 44 controls were evaluated. All subjects were boys and performed a clinical-psychopathological and neuropsychological battery. Five main domains of EFs and attention were studied. Executive functions-related neurocognitive abilities were used as control tasks. ADHD patients, inattentive and combined subtypes differ from controls on response inhibition, divided attention, phonological, and visual object working memory and on variability of reaction times measured with CPT. Comparison of ADHD subtypes, in five main domains of EFs, did not show evidence of different executive functioning profiles. Response inhibition can predict performance on working memory tests but it cannot predict performance on divided attention/set shifting and on sustained attention. ADHD boys exhibit a selective impairment on executive functions and attention tasks. These data suggest the involvement of partially independent neural circuits which control inhibition and divided attention in ADHD. Since right prefrontal cortex seems to be crucial in controlling response inhibition, while left dorsolateral prefrontal cortex seems important in modulating divided attention, these areas are deputated to be involved in the pathogenesis of neuropsychological deficits in ADHD subtypes. In addition, this study candidates the impairment in phonological and visual-object working memory as a possible neuropsychological trait in ADHD males with inattentive or combined subtypes.     

双相情感障碍患者家庭亲密度与适应性的调查

目的 了解双相情感障碍患者的家庭功能状况。方法 应用家庭亲密度与适应性量表(FACESⅡ-CV)作为调查工具,对51名双相情感障碍患者的家庭功能作调查,并与50名非精神病人做正常对照。结果 调查表明,双相情感障碍患者自身理想与实际家庭类型的比较、患者组与对照组理想的家庭类型的比较经统计学分析有显著性差别,患者组与对照组实际的家庭类型的比较、对照组理想与实际家庭类型的比较经统计学分析无显著性差别。结论 情感障碍患者的疾病复发可能与家庭功能状况有关,如果在疾病康复期指导中,加强家庭功能的心理治疗,可有助于降低疾病复发。     

Neuropsychological assessment of ADHD subtypes

Starting from a discussion of the validity of neuropsychological methods for the diagnosis of ADHD the results of an own study are presented. What is the diagnostic value of the German version of the CPT (Continuous Performance Task) and the DAT (Dortmunder Aufmerksamkeitstest) in discriminating ADHD subtypes (according to DSM-IV) and in which areas do the children of each subtype differ from a control group of normal children? The computer versions of the CPT and DAT were administered to 14 boys with the "combined subtype" of ADHD, 14 boys with the "predominantly inattentive type" of ADHD and 18 boys without clinical signs; all groups were matched in age and intelligence. Subsequently the mean differences between the various test parameters were assessed as to their significance. Contrary to other studies there were no significant differences either between both ADHS types or relative to the control group with regard to the CPT omission errors and the reaction time. There were differences in the reaction variability both between the ADHD subtypes and relative to the control group. Only the "combined subtype", not the "pre-dominantly inattentive type" differed from the control group as to the CPT commission errors. Regarding the DAT, there were significant differences between all three groups regarding both the solution quality and the response delay.     

Motor coordination and kinaesthesis in boys with attention deficit-hyperactivity disorder

In the current study, movement ability and underlying kinaesthetic processes of boys with attention deficit-hyperactivity disorder (ADHD) were compared with a group of control children. Two groups of 16 boys with either predominantly inattentive subtype ADHD (ADHD-PI) or combined subtype ADHD (ADHD-C) were compared with 16 control boys matched on age and verbal IQ. The findings demonstrated that the children with ADHD had significantly poorer movement ability than the control children. A high percentage of children with ADHD displayed movement difficulties consistent with developmental coordination disorder. In addition, the current study found that the type and degree of movement difficulty differed between subtypes. Children with ADHD-PI had significantly poorer fine motor skill while children with ADHD-C were found to experience significantly greater difficulty with gross motor skill. The severity of the children's inattentive symptomatology was found to be a significant predictor of motor coordination difficulties. Kinaesthetic sensitivity was not found to differ significantly between the groups.     

Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment.

BACKGROUND: To date, nearly all research of subtype differences in ADHD has been performed in children and only two studies, with conflicting results, have covered this subject in adults with ADHD. OBJECTIVE: This study examined subtype differences in the clinical presentation of ADHD-symptoms, related psychopathological features, psychosocial functioning and comorbid psychiatric disorders in adults with ADHD. METHOD: One hundred and eighteen adults with ADHD, diagnosed according to DSM-IV criteria, and a population based control group underwent diagnostic evaluations with clinical interviews for ADHD, DSM-IV disorders and demographic features. Comparisons were made between ADHD combined type (n=64), predominantly inattentive type (n=30) and predominantly inattentive type, anamnestically combined type (n=24), relative to each other and to a community control group (n=70). RESULTS: The four groups did not differ in age and gender composition. All ADHD groups had significantly less education, were significantly more often unemployed and reported significantly more lifetime psychiatric comorbidity than controls. In comparison to each other, the three ADHD groups differed mainly in core symptoms and the pattern of comorbid psychiatric disorders, whereas no prominent differences in associated psychopathological features and most of the assessed psychosocial functions could be found. Patients with ADHD combined type and inattentive, anamnestically combined type both presented with significantly more hyperactive symptoms and also showed more impulsive symptoms than those with the predominantly inattentive type. With a similar overall lifetime psychiatric comorbidity in the three groups, patients with ADHD combined type and inattentive, anamnestically combined type suffered significantly more from lifetime substance use disorders than patients with predominantly inattentive type. CONCLUSION: Our results clearly show impaired psychosocial adjustment and elevated risk for additional psychiatric disorders in adults with all subtypes of ADHD, compared to healthy controls. They provide preliminary evidence that in adult ADHD there might be a subgroup of patients, which is classified as predominantly inattentive subtype according to current diagnostic criteria, but which in its clinical presentation is in between ADHD combined and inattentive type. Further studies are needed to evaluate this finding and to gain a clear picture of its validity.     

Neuropsychological executive functions and DSM-IV ADHD subtypes.

OBJECTIVE: To evaluate and compare a focused set of component neuropsychological executive functions in the DSM-IV attention-deficit/hyperactivity disorder combined (ADHD-C) and inattentive (ADHD-I) subtypes. METHOD: The Stop task, Tower of London, Stroop task, Trailmaking Test, and output speed measures were completed by 105 boys and girls aged 7-12 classified as either DSM-IV ADHD-C (n = 46), ADHD-I (n = 18), or community control (n = 41). RESULTS: Both subtypes had deficits on output speed. A group x gender interaction was observed on the Stop task: boys with ADHD-C were impaired versus boys with ADHD-I, whereas girls in the two subtypes did not differ. The ADHD-C type had a deficit in planning. Neither ADHD group had a deficit in interference control per se, although they were slower than controls on the Stroop tasks. CONCLUSIONS: ADHD-I shares neuropsychological deficits with ADHD-C in the domain of output speed; on most domains the subtypes did not differ. Neuropsychological distinctions between these ADHD subtypes may be few, depending on which domain of executive functioning is assessed, and these distinctions differ by gender. In the case of boys, the two subtypes may be distinguished by the specificity of motor inhibition deficits to ADHD-C.     

Psychiatric comorbidity associated with DSM-IV ADHD in a nonreferred sample of twins

OBJECTIVE: To test the external validity of the dimensions and subtypes of DSM-IV attention-deficit/hyperactivity disorder (ADHD) by assessing the prevalence of psychiatric comorbidity. METHOD: Eight- to 18-year-old twins with ADHD (n = 105) and without ADHD (n = 95) were recruited through local school districts. Comorbid disorders were assessed by structured diagnostic interviews with the parent and child and by a behavioral rating scale completed by the child's classroom teacher. RESULTS: Symptoms of inattention were associated with lower intelligence and higher levels of depression, whereas symptoms of hyperactivity-impulsivity were associated more strongly with symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD). All DSM-IV subtypes were associated with higher rates of ODD and CD in comparison with controls, and the combined type was associated with more disruptive behavior disorder symptoms than the other 2 subtypes. The combined type and predominantly inattentive type were associated with more symptoms of depression than controls or the predominantly hyperactive-impulsive type. CONCLUSIONS: These results provide support for the discriminant validity of the dimensions and subtypes of DSM-IV ADHD and suggest that clinicians should carefully screen for comorbid disorders as part of a comprehensive assessment of ADHD.