成人ADHD患者脑电α功率不对称性与生态执行功能的相关性

目的:探究成人注意缺陷多动障碍(ADHD)患者静息态脑电α绝对功率不对称性与生态执行功能的相关性。方法:选取成人ADHD患者49例及正常对照45例,用执行功能行为评定量表成人版(BRIEF-A)评估生态执行功能,并记录静息态脑电,分析不同脑区α绝对功率不对称性差异并探讨其与生态执行功能的相关性。结果:ADHD患者双侧额部、前额的α绝对功率不对称性低于正常对照(均P<0.05);成人ADHD在BRIEF-A自评问卷的行为管理指数和元认知指数维度得分均高于对照(均P<0.001);在正常对照中双侧额部(r=0.43,P<0.05)、前额(r=0.43,P<0.05)的α绝对功率不对称性与其自我监控评分呈现正相关,但成人ADHD患者未见此相关性(P>0.05)。结论:成人ADHD患者生态执行功能存在缺陷,额部α绝对功率不对称性与自我监控能力关联性的消失可能是其执行功能受损的神经电生理机制。     

成人注意缺陷多动障碍生态执行功能特点

目的:探讨成人注意缺陷多动障碍(ADHD)生态执行功能特点。方法:对41名符合Con-ners’成人ADHD诊断会谈(Conners’Adult ADHD Diagnostic Interview for DSM-IV,CAADID)中ADHD诊断标准的门诊患者和42名年龄、受教育年限与之匹配的正常对照,进行执行功能行为评定量表成人版(BRIEF-A)自评问卷评定。结果:成人期仍符合CAADID诊断标准的ADHD患者,其BRIEF-A自评问卷,经多重检验校正后行为管理指数和元认知指数两个维度得分均高于对照组(均P<0.01),抑制、感情控制、任务启动、任务监测4个因子得分也高于对照组(均P<0.05)。结论:ADHD成人患者生态执行功能可能存在缺陷。     

注意缺陷多动障碍儿童父母的执行功能生态学特征

目的:探讨注意缺陷多动障碍(ADHD)儿童父母执行功能生态学特征。方法:选取147名符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的注意缺陷多动障碍儿童的父母亲,130名无注意缺陷多动障碍及其他神经疾患的正常儿童的年龄、受教育年限匹配的父母亲,让其分别填写执行功能行为评定量表成人问卷(自评和他评)(BRIEF-A),比较两组对象执行功能。结果:ADHD组父母BRIEF-A自评、他评量表,在执行总分、行为管理指数和元认知管理指数及其所属的抑制、转换、情绪控制、自我监控、启动、工作记忆、计划和组织因子方面,均明显低于对照组(均P<0.05);而父母自评的任务监控因子两组差异无统计学意义(P>0.05)。结论:注意缺陷多动障碍患儿父母的执行功能存在一定的缺陷。     

成人注意缺陷多动障碍患者的执行功能

目的:探讨我国汉族成人注意缺陷多动障碍(attention deficit hyperactive disorder,ADHD)患者的执行功能特点。方法:使用病例对照研究,对30名符合Conners’成人ADHD诊断会谈中ADHD诊断标准的门诊患者,24名年龄和受教育年限与之匹配的正常对照,进行执行功能任务测验(Stroop色词干扰、数字字母连线、数字广度、汉诺塔和流畅性测验),测查执行功能的抑制、转换、工作记忆、计划和流畅性等成分,比较两组差异。结果:成人ADHD患者在工作记忆任务测验(倒背数字数)表现差于正常成人,差异有统计学意义(P<0.05)。但在抑制、转换、计划和流畅性任务测验中表现与正常成人差异无统计学意义。结论:本研究提示,中国汉族成人ADHD患者在工作记忆方面存在缺陷,而在抑制、转换、计划和流畅性方面无明显缺陷。     

脑外伤及胚脑移植患者脑电地形图观察

目的：探讨脑电地形图在脑外伤和胚脑移植病人临床价值。方法：应用NDC-200型脑电地形图仪对临床颅脑外伤患者及胚脑移植患者进行脑电信号检测和脑电功率谱分析。结果：脑外伤患者损伤侧病理性δ波和θ波的绝对功率值和相对功率值均明显地高于健侧和对照组；但经胚脑移植后，随着临床症状的改善，上述现象明显恢复并与正常对照组接近。结合在鼠脑额叶皮层损伤后进行胚脑移植的脑电地形图资料及形态学观察证实脑电地形图有改善的大鼠均有移植区存活良好的佐证。结论：脑电地形图能准确地定性，定量和定位反映脑功能状态的改变，并且可作为中枢神经系统再生功能测试手段之一。     

成人注意缺陷多动障碍的24周团体认知行为治疗开放试验

目的:初步评估团体认知行为治疗(CBT)对成人注意缺陷多动障碍(ADHD)核心症状、执行功能、自尊水平及生活质量等的效果。方法:对27例成人ADHD患者进行12周CBT和3次后期巩固治疗(4周1次),使用ADHD评定量表(ADHD-RS)、执行功能行为评定量表成人版(BRIEF-A)、自尊量表(SES)和世界卫生组织生存质量测定量表简表(WHOQOL-BRIEF)评估疗效。采用多次重复测量方差分析对第1周、第12周和第24周的各指标得分进行比较。结果:24周CBT后ADHD-RS得分及BRIEFA中转换和任务监控得分均低于第1周得分(均P<0.05),SES得分及WHOQOL-BREF的生理领域得分均高于第1周得分(均P<0.05)。结论:包含3次后期巩固治疗阶段的团体认知行为治疗可改善成人注意缺陷多动障碍患者的核心症状、执行功能、自尊水平和生活质量。     

执行功能行为评定量表成人版自评问卷的信效度

目的:评价执行功能行为评定量表成人版(Behavior Rating Inventory of Executive Function-A-dult Version,BRIEF-A)自评问卷在我国文化背景下的适用性。方法:纳入符合ICD-10诊断的精神分裂症31例、抑郁发作38例,及符合DSM-IV-TR诊断的成人注意缺陷多动障碍(attention deficit/hyperactivity dis-order,ADHD)40例,另外选取来自北京大学医学部的2002级临床班学生及其家长、北京大学第六医院的职工、北京市九一小学学生的父母共285人为正常对照组。用BRIEF-A自评问卷(包括总分GEC、行为管理指数BRI、元认知指数MI和抑制、转换、情感控制、自我监控、任务启动、工作记忆、计划、组织、任务监控9个因子)进行施测。随机选取40例正常对照间隔3周后再次完成BRIEF-A自评问卷,以评价自评问卷的重测信度;随机选取30例正常对照和38例患者完成执行功能失常量表自评问卷(Dysexecutive Ques-tionnaire,DEX),以评价自评问卷的量表效标效度;随机选取31例正常对照和30例成人ADHD患者完成Stroop色词干扰、连线测试、Rey复杂图形记忆任务、汉诺塔、言语流畅性任务评定,以评价自评问卷的神经心理测验效标效度。结果:(1)BRIEF-A自评问卷的GEC、BRI、MI重测相关系数分别为0.85、0.86、0.78,9个因子的相关系数在0.61～0.76之间(P0.01),GEC、BRI、MI的Cronbachα系数为0.86～0.92,各因子的Cronbachα系数为0.65～0.88(P0.01)。(2)BRIEF-A自评问卷的GEC、BRI、MI与DEX总分的相关系数分别为0.77、0.73、0.70,9个因子与DEX总分相关系数为0.39～0.78(P0.05)。抑制因子与Stroop第三试错误数、字义干扰时、数字字母连线测试转换时间呈正相关(r=-0.28～0.42,P0.05),MI与言语流畅性前一分钟正确数、后一分钟正确数、正确总数、数字字母连线的转换时间呈正相关(r=0.36～0.44,P0.05)。(3)与性别、年龄、受教育程度匹配的对照组相比,成人ADHD组(除转换、工作记忆、计划因子外)、精神分裂症组、抑郁发作组的GEC、BRI、MI和各因子原始平均分更高[如,总分成人ADHD组(1.76±0.33),对照组(1.55±0.29);P=0.004]。结论:执行功能行为评定量表成人版自评问卷具有良好的信效度,适用于我国精神疾病患者和正常人群。     

成人注意缺陷多动障碍的团体认知行为治疗效果观察

目的:探讨团体认知行为治疗对成人注意缺陷多动障碍(ADHD)核心症状、执行功能、焦虑抑郁情绪的效果。方法:对40例成人ADHD患者进行12周团体认知行为治疗,使用ADHD评定量表(ADHD-RS)、执行功能行为评定量表成人版(BRIEF-A)、焦虑自评量表(SAS)以及抑郁自评量表(SDS)评估疗效。结果:ADHD评定量表总分逐渐降低,以第1周评分作为基线值,对比12周治疗进行两两比较,结果ADHD评定量表总分第4-12周与第1周均有显著差异。BRIEF除情感控制分量表外,其余量表分值第12周均显著低于第1周。第12周SAS以及SDS量表总分均显著低于第1周。结论:团体认知行为治疗对成人ADHD的核心症状、执行功能、焦虑抑郁症状具有良好的治疗效果。     

注意缺陷多动障碍患儿的脑电图与临床特点

目的:分析注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)患儿脑电图改变,探讨注意缺陷多动障碍患儿临床与脑电图改变的关系。方法:将在本院儿童神经专科确诊的116例注意缺陷多动障碍患儿的脑电与临床特点进行分析总结。结果:116例ADHD脑电图中正常24例(20%),正常范围29例(25%),异常63例(54.3%)异常脑电图均表现为枕区α波的频率慢于该年龄组正常标准2Hz以上。基本波不规则,间有大量多形性θ波或中高幅θ活动阵发性出现。结论:注意缺陷多动障碍(ADHD)患儿脑电图检查显示脑电的非特异性改变。可为临床诊断和鉴别诊断提供一定的辅助诊断参考价值。     

抽动障碍（TD）儿童脑电特征及脑功能研究

目的比较TD儿童与对照组儿童脑电图、脑功能的特征及智力情况,探讨抽动障碍（TD）儿童的脑功能特征及可能影响儿童智力的因素。方法采用病例对照研究方法,以4～15岁126例TD儿童及81例对照组儿童作为研究对象,所有儿童都进行脑电图及额部脑功能检查,并进行中国比内智力测验。结果①TD组额部脑电频率均慢于对照组（P〈0．05）,右前额明显（P〈0．05）;②TD组前额θ波脑电功率及θ／SMR、θ／β、α／SMR、α／β脑电功率比值均高于对照组;⑧TD组儿童前额脑电频率与前额θ波、前额θ／β脑电功率比值有负相关关系;④TD组儿童智商低于对照组。结论本研究显示TD儿童的脑电活动落后于正常对照组儿童,尤其是前额叶功能不足,智力低于正常儿童。     

A meta-analysis of the sensitivity and specificity of the Stroop Color and Word Test with children.

The purpose of this paper is to examine the extent to which the Stroop Color-Word Test demonstrates sensitivity and specificity for the identification of executive function deficits in children and adolescents. Meta-analytic methods were used to identify executive function deficits associated with attention deficit hyperactivity disorder (ADHD) and other developmental disorders. Weighted effect sizes were calculated for all studies found that compared groups of children on the Stroop task. Results indicated that across studies, children and adolescents with ADHD fairly consistently exhibited poorer performance when compared to individuals without clinical diagnoses on the Stroop task as measured by the weighted Word, Color, Color-Word, and Interference scores. The Stroop task did not discriminate ADHD groups from other clinical groups consistently across studies. In conclusion, while impaired performance of the Stroop task may be indicative of an underlying neurological disorder related to frontal lobe dysfunction, poor performance is not sufficient for a diagnosis of ADHD.     

Neuropsychological performance deficits in adults with attention deficit/hyperactivity disorder.

Neuropsychological deficits in children diagnosed with attention deficit/hyperactivity disorder (ADHD) have been well documented utilizing various neuropsychological tests. Only recently has research begun to examine if similar deficits are present in adults with ADHD. A neuropsychological testing battery was constructed that assessed verbal learning and memory, psychomotor speed, and sustained attention--all demonstrated to be deficient in individuals with ADHD. Fifty-six self-referred nonmedicated adults with a DSM-IV diagnosis of ADHD and 38 normal comparison adults participated. ADHD adults demonstrated verbal and nonverbal memory deficits and decreased psychomotor speed compared to normal controls. Differences between ADHD and normal adults were not documented on traditional measures of executive functioning. A pattern of results emerged whereby ADHD adults' performance, particularly with regard to psychomotor speed, became more impaired as task complexity increased. This study's results largely corroborate similar neuropsychological testing results in ADHD children and recent ADHD adult findings, and support a frontal lobe dysfunction hypothesis of ADHD.     

青少年及成年孤独症谱系障碍患者社交技能训练的疗效

目的:探讨社交技能训练对青少年和成人孤独症谱系障碍(ASD)患者社会交往障碍的疗效。方法:入组符合美国精神障碍诊断与统计手册第5版(DSM-5)ASD诊断标准的12~30岁被试44例,分为训练组(n=22)和对照组(n=22)。对训练组进行为期14周的社交技能训练,训练前(基线)和训练结束(终点)时,对两组患者进行异常行为量表(ABC)和社交反应量表(SRS)的评定以及心理推理任务和执行功能测查任务的评估。结果:训练组终点的ABC总分和社会退缩因子分,SRS总分和社交知觉、社交认知、社交沟通因子分均低于基线(均P<0.05),心理推理的二级错误信念任务的通过率高于基线(P<0.05),执行功能的Rey复杂图形记忆任务中的延迟记忆结构分、延迟记忆细节分高于基线,连线测验中的数字字母连线时间、B测验完成时-A测验完成时短于基线(均P<0.05)。而对照组在终点时,除ABC社会退缩因子外,其余上述项目与基线时相比差异均无统计学意义(均P>0.05)。结论:社交技能训练能够有效改善青少年和成年ASD患者的整体症状和社会交往障碍,还能有效提高青少年和成年ASD患者的心理推理能力和执行功能。     

Wisconsin Card Sorting Test with children: a meta-analytic study of sensitivity and specificity

More and more frequently the presence of executive function deficits appears in the research literature in conjunction with disabilities that affect children. Research has been most directed at the extent to which executive function deficits may be implicated in specific disorders such as attention deficit hyperactivity disorder (ADHD); however, deficits in executive function have been found to be typical of developmental disorders in general. The focus of this paper is to examine the extent to which one frequently used measure of executive function, the Wisconsin Card Sorting Test (WCST), demonstrates sensitivity and specificity for the identification of those executive function deficits associated with ADHD as well as its use with other developmental disorders through meta-analytic methods. Evidence of sensitivity of the WCST to dysfunction of the central nervous system is reviewed. Effect sizes calculated for all studies compared groups of children on differing variables of the WCST. The results of this meta-analysis suggest that across all of the studies, individuals with ADHD fairly consistently exhibit poorer performance as compared to individuals without clinical diagnoses on the WCST as measured by Percent Correct, Number of Categories, Total Errors, and Perseverative Errors. Notably, other various clinical groups performed more poorly than the ADHD groups in a number of studies. Thus, while impaired performance on the WCST may be indicative of an underlying neurological disorder, most likely related to frontal lobe function, poor performance is not sufficient for a diagnosis of ADHD. Implications for further research are presented.     

Neuropsychological evaluation of deficits in executive functioning for ADHD children with or without learning disabilities

This study investigates multiple aspects of executive functioning in children with attention deficit/hyperactivity disorder (ADHD). These areas include attentional components, impulsiveness, planning, and problem solving. The rationale of the study is based on neurophysiological studies that suggest frontal lobe dysfunction in ADHD. As frontal lobe functioning is related to abilities in executive control, ADHD is hypothesised to be associated with deficits in various areas of executive functioning. The specific effect of comorbidity of learning disability (LD) was also investigated. Eighty-three children with ADHD and 29 age-matched controls (age 7-13) participated in the study. A battery of neuropsychological tests was utilized to evaluate specific deficits in speed of processing, selective attention, switching attention, sustained attention, attentional capacity, impulsiveness, planning and problem solving. Findings indicated that children with ADHD have slower verbal responses and sustained attention deficit. Deficits in selective attention and attentional capacity observed were largely related to the presence of LD. No specific deficit associated with ADHD or the comorbidity of LD was identified in switching attention, impulsiveness, planning, and problem solving. These results revealed that ADHD is not associated with a general deficit in executive functioning. Instead, ADHD is related to a specific deficit in regulation for attentional resources. The importance of isolating the deficit related to LDs for examining the specific deficit associated with ADHD is highlighted. Results also emphasised the importance of isolating the effect of lower level of abilities (e.g., speed of processing) and the utilization of specific definition for the examination of executive functions.     

抑郁症患者脑电地形图改变对认知功能及与疗效的影响

目的:探讨抑郁症患者额颞叶脑电功率改变与认知功能及疗效的关系。方法:对40例抑郁症患者入院1周内行脑电地形图检查,并和32例正常对照组进行对照分析;同时对患者在治疗前后进行汉密尔顿抑郁量表(HAMD)评定。结果:(1)研究组额叶脑波α1(t=2.243,2.968,3.688,3.918),δ(t=3.639,2.517),θ(t=2.519,3.613,3.730)功率明显高于对照组,差异具有统计学意义(P0.05);(2)研究组颞叶脑波α2(t=-2.103,-2.944,-3.200,-4.548),α3(t=-3.102,-2.752,-3.047,-4.094),β(t=-3.015,-2.584,-3.842)功率明显低于对照组,差异具有统计学意义(P0.05);(3)左前额δ波功率与第2周末HAMD减分率有显著负相关(t=-2.429,P0.05);(4)左前额及右前颞β波功率、左前颞δ波功率与第6周末HAMD减分率有显著负相关(t=-2.365,-3.107,-3.979;P0.05);(5)右中颞δ波功率与第6周末HAMD减分率有显著正相关(t=2.248,P0.05)。结论:抑郁症患者存在额颞叶功能损伤影响认知功能;其抗抑郁剂治疗起效时间可能与左前额δ波功率有关;左前额及右前颞β波功率值可作为疗效的观察指标之一。     

Neuropsychological Evaluation of Deficits in Executive Functioning for ADHD Children With or Without Learning Disabilities

This study investigates multiple aspects of executive functioning in children with attention deficit/hyperactivity disorder (ADHD). These areas include attentional components, impulsiveness, planning, and problem solving. The rationale of the study is based on neurophysiological studies that suggest frontal lobe dysfunction in ADHD. As frontal lobe functioning is related to abilities in executive control, ADHD is hypothesised to be associated with deficits in various areas of executive functioning. The specific effect of comorbidity of learning disability (LD) was also investigated. Eighty-three children with ADHD and 29 age-matched controls (age 7-13) participated in the study. A battery of neuropsychological tests was utilized to evaluate specific deficits in speed of processing, selective attention, switching attention, sustained attention, attentional capacity, impulsiveness, planning and problem solving. Findings indicated that children with ADHD have slower verbal responses and sustained attention deficit. Deficits in selective attention and attentional capacity observed were largely related to the presence of LD. No specific deficit associated with ADHD or the comorbidity of LD was identified in switching attention, impulsiveness, planning, and problem solving. These results revealed that ADHD is not associated with a general deficit in executive functioning. Instead, ADHD is related to a specific deficit in regulation for attentional resources. The importance of isolating the deficit related to LDs for examining the specific deficit associated with ADHD is highlighted. Results also emphasised the importance of isolating the effect of lower level of abilities (e.g., speed of processing) and the utilization of specific definition for the examination of executive functions.     

Neurocognitive functioning and magnetic resonance imaging in children with sickle cell disease

OBJECTIVE: To examine neurocognitive functioning in children classified with overt cerebral vascular accidents (CVAs), silent infarcts, or without central nervous system (CNS) pathology on magnetic resonance imaging. METHODS: Participants were 63 children and adolescents with sickle cell disease (SCD). RESULTS: Children with overt CVAs and silent infarcts differed from their peers without CNS pathology on measures of attention and executive functioning. CONCLUSIONS: We consider these deficits the result of the high frequency of frontal lobe deficits incurred by children with SCD. Recommendations include the use of tests designed to measure attention and executive functioning as a way of screening children with SCD for possible CNS pathology. We also suggest that future research examine the mechanism underlying frontal lobe involvement for individuals with SCD.     

Relation between resting EEG to cognitive performance and clinical symptoms in adults with attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) in children is characterized by elevated levels of slow wave activity and reduced fast wave activity in resting-state electroencephalogram (EEG). In adults with ADHD, resting-state EEG findings are scarce and inconsistent. The present study examined whether the disparate findings are due EEG recording conditions (i.e., eyes-open vs. eyes-closed). A second goal of the current study was to assess relations between EEG spectral indices to performance measures obtained using a stop-signal task, and to behavioral ADHD symptoms. The present study included 24 adults with ADHD and 24 control adults. The EEG results showed a greater reduction in alpha power from eyes-closed to eyes-open (i.e., alpha attenuation) in ADHD compared to controls. In addition, theta/beta ratio was negatively correlated to the speed of responding to choice stimuli. These findings were interpreted vis-à-vis a biophysical model assuming that the hypo-arousal in ADHD is due to an overdrive of the nucleus coeruleus resulting in inhibitory activity of the thalamic reticular nucleus.