注意缺陷多动障碍及抽动秽语综合征患儿事件相关电位P300的研究进展

注意缺陷多动障碍和抽动秽语综合征是儿童和青少年时期常见的精神神经障碍,影响患儿精神行为发育,出现学习能力差、认知功能受损、社会适应能力降低等情况,对社会和家庭造成沉重负担。近年来研究显示事件相关电位P300对儿童的认知评估有较好的指导意义。该文对注意缺陷多动障碍及抽动秽语综合征患儿事件相关电位P300的有关研究文献进行综述,比较ADHD及TS事件相关电位的差异,讨论其可能的影响机制。     

Review of the evidence for the management of co-morbid Tic disorders in children and adolescents with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with prevalence ranging between 5% and 12% in the developed countries. Tic disorders (TD) are common co-morbidities in paediatric ADHD patients with or without pharmacotherapy treatment. There has been conflicting evidence of the role of psychostimulants in either precipitating or exacerbating TDs in ADHD patients. We carried out a literature review relating to the management of TDs in children and adolescents with ADHD through a comprehensive search of MEDLINE, EMBASE, CINAHL and Cochrane databases. No quantitative synthesis (meta-analysis) was deemed appropriate. Meta-analysis of controlled trials does not support an association between new onset or worsening of tics and normal doses of psychostimulant use. Supratherapeutic doses of dextroamphetamine have been shown to exacerbate TD. Most tics are mild or moderate and respond to psychoeducation and behavioural management. Level A evidence support the use of alpha adrenergic agonists, including Clonidine and Guanfacine, reuptake noradrenenaline inhibitors (Atomoxetine) and stimulants (Methylphenidate and Dexamphetamines) for the treatment of Tics and comorbid ADHD. Priority should be given to the management of co-morbid Tourette’s syndrome (TS) or severely disabling tics in children and adolescents with ADHD. Severe TDs may require antipsychotic treatment. Antipsychotics, especially Aripiprazole, are safe and effective treatment for TS or severe Tics, but they only moderately control the co-occurring ADHD symptomatology. Short vignettes of different common clinical scenarios are presented to help clinicians determine the most appropriate treatment to consider in each patient presenting with ADHD and co-morbid TDs.     

注意缺陷多动障碍儿童的睡眠结构研究

目的探讨注意缺陷多动障碍(ADHD)儿童的睡眠结构。方法2005-06—2006-04用多导睡眠监护仪(PSG)对首都儿科研究所神经内科就诊的41例ADHD患儿及30例正常儿童进行全夜睡眠结构检测。结果41例ADHD儿童中混合型(ADHD-C)24例、注意缺陷型(ADHD-I)11例、多动/冲动型(ADHD-H)6例。其中男35例,女6例(ADHD-I3、ADHD-C2、ADHD-H1例)。与对照组比较ADHD组REM潜伏期短、睡眠潜伏期延长、睡眠效率降低,差异有显著性(P<0·05);ADHD-C儿童睡眠Ⅱ期百分比较ADHD-I增加,差异有显著性(P<0·05);ADHD组睡眠周期性肢体运动(PLMS)发生率为41·5%,正常组PLMS发生率为13·33%,差异有显著性(P<0·05);ADHD组及正常对照组脑电图未见疒间性放电。结论(1)ADHD儿童存在REM睡眠结构的改变、入睡困难及睡眠效率降低;(2)PLMS也是导致ADHD儿童睡眠质量下降的原因之一;(3)ADHD儿童以男孩为主,女孩以注意力缺陷型为主。对学习困难的女孩应注意是否患有ADHD。     

注意缺陷多动障碍的定量脑电图研究进展

注意缺陷多动障碍是儿童期最常见的精神疾病之一,其临床表现为注意力不集中、多动和冲动,可严重影响患者的家庭生活、个人成就及社交关系,目前对该病仍缺乏客观指标进行诊断及评估疗效。脑电图检查可无创性地记录脑电活动,反映脑功能情况。该文就近年来定量脑电图在注意缺陷多动障碍方面的研究进展作一综述。     

影响Tourette综合征共患注意缺陷多动障碍的多因素分析

目的 探讨Tourette综合征(Tourette syndrome,TS)合并注意缺陷多动障碍(ADHD)(简称:TS+ADHD)的相关危险因素,为鸭+ADHD的预防、干预提供理论依据.方法 对门诊150例伴或不伴ADHD的TS患儿根据DSM-Ⅳ诊断标准分为单纯TS组和TS+ADHD组,两组各75例.采用自制问卷和家庭环境量表进行测评.将46个因素作为变量进行赋值,进行数量化处理.应用单因素和多因素分析方法对资料进行分析.结果 (1)TS+ADHD患儿家庭的亲密度、情感表达、知识性、娱乐性、组织性和道德宗教观得分低于对照组家庭;而矛盾性则高于正常对照家庭.(2)单因素分析发现TS+ADHD的相关危险因素包括:ADHD家族史阳性[比值比(OR)值=24.318]、家庭教育类型为非民主型(OR=18.617)、治疗延误时间长(OR=10.796)、母孕期吸烟(OR=9.094)、家庭矛盾性(OR=5.781)、出生时缺氧(OR=2.562)、父母文化程度低(OR=1.941)、低情感表达(OR=0.967).(3)进一步的多因素Logistic回归分析发现共有5个因素被选人回归方程,依次为:ADHD家族史阳性(OR=13.805)、家庭矛盾性(OR=8.459)、家庭教育类型为非民主型(OR=5.477)、父母文化程度低(OR=2.164)、母孕期吸烟(OR=2.075).结论 ADHD家族史阳性、家庭矛盾性、家庭教育类型为非民主型、父母文化程度低、母孕期吸烟是导致TS合并ADHD的关键危险因素.     

Complementary and alternative medicine use in children with attention deficit hyperactivity disorder

OBJECTIVES: The use of complementary and alternative medicines (CAM) is increasing in the general population. Attention deficit hyperactivity disorder (ADHD) is a chronic condition that has a major impact on children's functioning and has no cure, therefore many families may try CAM at some stage. We aimed to determine (i) the lifetime incidence of CAM use in a clinical sample of children with ADHD; (ii) parents' perceptions of the effectiveness of CAM for ADHD; and (iii) the proportion who informed their paediatrician. METHODS: The sample was drawn from patients aged 5-17 years with ADHD attending Royal Children's Hospital, Melbourne outpatient clinics from May to September 2003. A 20-item survey was posted to consenting families. RESULTS: From 105 surveys, 75 were returned (response rate 71.4%). Mean child age was 11.1 (SD 2.9, range 5.0-16.9) years; 65 (86.7%) were boys. Fifty (67.6%) families reported current or past CAM use. Of the 23 different therapies reported, the most common were modified diet (33 families), vitamins and/or minerals (16), dietary supplements (12), aromatherapy (12) and chiropractics (10). Reported effectiveness was variable. The factors most frequently rated as important in choosing CAM were minimizing symptoms (40 families), adding to the benefit of conventional treatment (30) and avoiding side-effects (29). Thirty-two (64%) of 50 families reported that they informed their paediatrician of their CAM use. CONCLUSION: Complementary and alternative medicines are commonly used in children with ADHD. Paediatricians should inquire about the use of CAM, and use available resources to help guide families in their therapeutic choices.     

哌醋甲酯治疗儿童注意缺陷多动障碍依从性的影响因素分析

目的：了解注意缺陷多动障碍（attention deficit hyperactivity disorder, ADHD）患儿接受药物治疗与否及服药依从性好坏的影响因素。方法：以188例符合DSM-Ⅳ诊断标准的首诊ADHD儿童为研究对象,完成相关症状评定及认知功能测试,评估哌醋甲酯治疗的依从性。结果：情绪状态好、较少逆反和多动行为的患儿及有精神疾病家族史、数字划消测验得分低者更倾向服药和（或）有更好的服药依从性。其中,logistic回归分析显示患儿不好动、逆反少、数字划消测验得分低是愿意接受药物治疗的预测因素,情绪状态得分高是服药依从性好的预测因素;注意缺陷为主型患儿较混合型患儿接受服药比例更高且服药依从性更好;而性别、年龄、症状严重程度等因素则并不影响是否接受治疗和（或）服药依从性。结论：要特别重视提高伴多动冲动及逆反行为ADHD患儿的服药依从性,改善患儿长期的社会功能。     

注意缺陷多动障碍混合型和注意缺陷型的神经心理特征分析

目的探讨注意缺陷多动障碍混合型、注意缺陷型与正常儿童的神经心理特征的差异。方法采用视觉记忆、Stroop效应、倒背数字、词汇流畅性、威斯康辛卡片分类、Temporal discounting等测验、分别测试124例注意缺陷多动障碍儿童（包括85例混合型和39例注意缺陷型）和124例正常儿童的视觉工作记忆、反应抑制能力、语音工作记忆、执行功能和延迟满足能力。结果ADHD儿童完成字义与字色相矛盾的字色命名时间[注意缺陷型：84（20）,混合型：98（31）]较正常组[70（28）]延长,错误数[注意缺陷型：3（3）,混合型：6（19）]较正常儿童[2（5）]增多（P〈0．01）;ADHD儿童倒背数字分数[注意缺陷型：3（3）,混合型：3（4）]较正常儿童[4（4）]低（P〈0．01）;延迟视觉记忆[注意缺陷型：19（5）,混合型19（5）]也较正常儿童[20（5）]低（P〈0．01）;ADHD儿童视觉工作记忆得分[注意缺陷型：21（3）,混合型：20（5）]较正常儿童[20（3）]明显偏低（P〈0．01）;ADHD儿童词汇流畅性错误数[注意缺陷型：1（1）,混合型2（1）]显著高于正常儿童[0（0）]（P〈0．01）;ADHD儿童的威斯康辛卡片分类错误数[注意缺陷型：15（17）,混合型：15（15）]显著高于正常儿童[13（13）],分类数[注意缺陷型：5（4）,混合型：5（4）]低于正常儿童[5（3）]（P〈0．01）;ADHD儿童的延迟满足能力显著低于正常儿童（P〈0．01）。ADHD的两种亚型之间在部分测试的结果差异有统计学意义,混合型的ADHD儿童受损更为明显（P〈0．01）。结论ADHD儿童存在视觉工作记忆、语音工作记忆、延迟满足能力、反应抑制等多项认知功能缺陷,其中混合型的儿童受损更为明显。     

注意缺陷多动障碍共患发展性阅读障碍儿童的智力特征

目的 探讨注意缺陷多动障碍(ADHD)共患发展性阅读障碍(DD)儿童的智力特征.方法 纳入ADHD共患DD儿童55例、单纯ADHD儿童150例、单纯DD儿童22例作为研究对象,采用韦氏儿童智力测验第四版(WISC-Ⅳ)测试3组儿童的智力水平,比较3组儿童的智力特征.结果 ADHD共患DD组、单纯ADHD组、单纯DD组3...     

Diagnosis and management of children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent childhood psychiatric disorder which is characterized by three core symptoms of inattention, hyperactivity and impulsivity. It is estimated that 5% to 10% of school aged children suffer from this disorder. This disorder is more common in boys than girls. Comorbidity is a major problem and is present in as many as two thirds of children with ADHD. A multiple modality approach to treatment which combines pharmacotherapy, psycho education, behaviour therapy, environmental changes and social skills training is recommended. The outcome of ADHD is variable and unless properly treated in early years may predispose the child to serious psychopathology in adulthood.     

脑电生物反馈治疗儿童注意缺陷多动障碍的临床分析

目的：注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童常见的一种行为障碍性疾病,在完成认知任务时脑电慢波（θ）活动增强,快波（β）活动减弱。该研究通过观察θ/β比值的变化、结合整和视听连续执行测试（integrated visual and auditory continuous performance test,IVA CPT）进行评估,探讨脑电生物反馈对儿童注意缺陷多动障碍的治疗效果。方法：对30例ADHD儿童进行脑电生物反馈治疗,抑制4~8 Hz的θ波,强化16~20 Hz的β波,观察θ/β比值的变化,采用IVA-CPT进行评估。结果：30例ADHD儿童经2个以上疗程的治疗,治疗后较治疗前脑电θ/β比值显著下降（P< 0.01）,综合反应控制商数、听反应控制商数、视反应控制商数,综合注意力商数、听注意力商数、视注意力商数均较治疗前有明显提高（P< 0.01）。结论：脑电生物反馈治疗可以降低θ/β比值,提高注意力,减少多动,是治疗儿童ADHD的一种有效方法。     

Attention deficit hyperactivity disorder

Objective;To identify ADHD children, to show the prevalence of the disorder in the age group of 5–12 years and to study their socio-demographic variables, associated medical and co-morbid psychological problems.Methods : This is a cross-sectional case study of ADHD children presenting to a child guidance clinic in a busy pediatric hospital over a one year period. The diagnosis of ADHD was based on DSM IV criteria.Results : Of the 238 children referred, 37 were diagnosed as ADHD. 64.9% of the referrals were from pediatricians. The prevalence of ADHD in pediatric clinic was 15.5%, the inattention subtype was predominant. The mean age of boys and girls with ADHD was 8.49 years and 6.82 years respectively. The male to female ratio was 6.4:1. Majority of patients were from middle socio-economic status belonging to Hindu families. 27.0% of children had developmental problems. Oppositional defiant disorder was the most prevalent while depression was the least prevalent co morbid problem.Conclusion : ADHD is prevalent in India and the bunch of these children are mostly presenting to the pediatrician. They need to be aware of the profile of this disorder for early detection and intervention.     

注意缺陷多动障碍患儿空间忽视的研究

目的 研究注意缺陷多动障碍(ADHD)患儿空间忽视的现象.方法 对32例男性ADHD患儿和32例正常儿童进行划星试验、线等分试验,以及智能测验等非忽视测验.结果 (1)ADHD患儿线等分测试结果为(-9.37±6.57),与对照组(-5.46±4.69)相比,差异有统计学意义(t=-2.735,P<0.01);ADHD患儿左侧划星试验成绩(11.44±5.55)差于对照组(16.34±4.82)(t=-3.78,P<0.01),且左侧较右侧(17.13±6.36)差,差异均有统计学意义(t=-3.09,P<0.01).(2)两组儿童线等分测验成绩均偏向"0"值的右侧(ADHD组t=-8.064,P<0.01;对照组t=-6.585,P<0.01),两侧划星测验成绩也较"正常值""27/27"差(ADHD组:左侧t=15.85,P<0.01;右侧t=-8.78,P<0.01.对照组:左侧t=-12.52,P<0.01;右侧t=-7.39,P<0.01).结论 ADHD患儿较正常儿童存在明显左侧空间忽视现象.     

Variations in prevalence of attention deficit hyperactivity disorder worldwide

Attention deficit hyperactivity disorder (ADHD) is among the most common, intensely investigated, and yet diagnostically controversial neurobehavioral conditions of childhood. The prevalence of ADHD has been reported with great variations among different studies, ranging from 2.2% to 17.8%. The aim of this review was to investigate the variables that influence the prevalence of ADHD and to derive a best estimate for the prevalence of the disorder. We reviewed all the 39 studies on ADHD prevalence appearing in the Pubmed and published since 1992. These studies indicate that ADHD is more common in boys than girls, in younger than older children and adolescents, in one-setting rather than two-setting screening studies, in studies based on DSM-IV rather than DSM-III-R criteria. Additional factors that may well influence prevalence rates include source of information and assessment of clinical impairment. In conclusion, our findings suggest that population characteristics, methodology features, ethnic and cultural differences and diagnostic criteria involved in studies affect the prevalence of ADHD. Standardized designs may lead to firm conclusions on the true prevalence of ADHD, the estimation of which seems impossible to be achieved by reviewing the already existing literature.     

盐酸哌甲酯控释片治疗注意缺陷多动障碍疗效观察

目的：盐酸哌甲酯是目前治疗注意缺陷多动障碍（ADHD）的首选药物。以往多使用传统的速释哌甲酯片，现已研制出渗透泵控释的哌甲酯，并且已在我国上市使用。该研究对盐酸哌甲酯控释片对ADHD的治疗疗效及安全性进行评价。方法：将99例ADHD儿童按随机原则分为哌甲酯控释片组与速释哌甲酯片组。接受6周治疗观察，采用主要疗效评定指标（SNAP-IV家长评定量表）及次要疗效评定指标(IVA-CPT）进行疗效评定。结果：共50例患儿完成6周治疗，哌甲酯控释片组治疗有效率（83.3%）、完全缓解率（44%）均高于速释哌甲酯组（有效率75%、完全缓解率25%），两组治疗6周前后各量表分值与基线值相比差异均有显著性（P＜0.01），两组间各量表分值变化的平均值差异无显著性。两组治疗期间不良事件发生率相似。结论： 哌甲酯控释片用于ADHD治疗安全有效，且每日只需1次服药，用药方便。     

注意缺陷障碍儿童血清兴奋性和抑制性氨基酸的检测及分析

目的　通过检测注意缺陷障碍(ADHD)儿童血中兴奋/抑制性氨基酸代谢水平,探求它们与ADHD的关系及与心理行为的相关性。方法　采用反向高效液相色谱法,测定2 0 0 3年8月在上海第二军医大学附属长征医院随机抽取的5 8例注意缺陷障碍儿童(ADHD组:其中注意缺陷为主型2 2例;多动 冲动为主型4例;混合型32例)和30例健康对照儿童血清兴奋性氨基酸中的谷氨酸(Glu)、天冬氨酸(Asp)和抑制性氨基酸甘氨酸(Gly)的浓度并进行比较。结果　(1)ADHD组儿童血清兴奋性氨基酸Glu、Asp浓度分别为(16 9. 13±2 6 . 6 2 ) μmol/L和(2 9 .19±2 . 5 6 ) μmol/L ,显著低于对照组(P <0 .0 1) ,而抑制性氨基酸Gly浓度为(489. 78±96 . 2 6 ) μmol/L ,显著高于对照组(P <0 .0 5 )。(2 )不同类型ADHD儿童之间血清兴奋性和抑制性氨基酸浓度未见有统计学意义上的差异。(3)兴奋性和抑制性氨基酸浓度和DSM Ⅳ父母版所得各项分数之间无相关性。结论　ADHD儿童血清中存在兴奋/抑制性氨基酸的失调,此种失调可能参与了ADHD的病理生理过程。     

注意缺陷多动障碍综合征患儿睡眠结构的初探

目的 探讨注意缺陷多动障碍（ADHD）综合征患儿的睡眠结构，睡眠中[XCJIANX5.tif]性放电及睡眠周期性肢体运动（PLMS）的情况；比较ADHD各亚型间睡眠结构的差异。方法 利用多导睡眠监护仪对2005年6月至2006年11月在首都儿科研究所神经科门诊就诊的符合DSM-Ⅳ诊断标准的58例ADHD患儿及30名正常儿童进行整夜睡眠结构监测。结果 ADHD组58例，其中4例睡眠监测未完成，实际完成54例。ADHD组中混合型（ADHD-C）31例（57.4％，31/54），注意缺陷型（ADHD-I）15例（27.8％，15/54），多动/冲动型（ADHD-H）8例（14.8％，8/54）。①与对照组比较，ADHD组快速动眼期（REM）潜伏期短、睡眠潜伏期延长和睡眠效率降低，差异有统计学意义（P<0.05）；②ADHD-C患儿睡眠Ⅱ期百分比较ADHD-I增加，差异有统计学意义（P<0.05）；③ADHD组PLMS发生率为37.0%（20/54），对照组PLMS发生率为13.3%（4/30），差异有统计学意义（P<0.05）；④ADHD组和对照组EEG未见[XCJIANX5.tif]性放电。结论 ①ADHD患儿存在REM睡眠结构的改变、入睡困难及睡眠效率降低；②睡眠Ⅱ期百分比的增多可使ADHD-C较ADHD-I有更多和更重的症状；③ADHD患儿睡眠过程中PLMS发生率较对照组显著升高，PLMS也是导致ADHD患儿睡眠质量下降的原因之一。     

中国精神障碍分类方案与诊断标准在儿童注意缺陷多动障碍中的应用研究

目的　探讨中国精神障碍分类方案与诊断标准第三版 (CCMD 3)对注意缺陷多动障碍 (ADHD)临床诊断和流行病学调查中的适用性。方法　CCMD 3对门诊就诊的ADHD儿童和流行病学调查筛查出的ADHD进行再诊断。门诊就诊的ADHD儿童经两位儿童精神病学专科医师临床诊断 ,共 73例 ,为临床组 ;长沙市某小学和某中学学生使用康奈氏简明父母和 (或 )教师问卷筛查阳性 ,经两位医师临床诊断 ,共 5 8例 ,为流调组 ;在校儿童中去除临床诊断为ADHD者 ,共 5 17例 ,为对照组。请三组儿童父母填CCMD 3诊断表。结果　临床组符合CCMD 3诊断标准者 5 9例 ,占 80 8%。流调组符合CCMD 3诊断标准者 35例 ,占 6 0 3%。临床组注意障碍因子、多动因子得分高于流调组 ,两ADHD组得分高于对照组 ,差异有高度显著性。符合临床诊断而不符合CCMD 3诊断标准者有 76 % ,是因为多动因子达不到CCMD 3诊断标准。结论　CCMD 3将符合诊断的项目减少为 4项 ,对症状的描述更符合我国习惯 ,因此比DSM Ⅳ和ICD 10更适用于我国。在诊断ADHD时应考虑民族、文化、年龄、性别、起病年龄以及家长对ADHD的认识等因素。     

The efficacy of neurofeedback in the management of children with attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder (ADHD) is a behavioural disorder characterized by an inappropriate level of inattention with or without impulsivity or overactivity. The estimated prevalence of ADHD is 7% to 10% in boys and 3% in girls aged four to 11 years. The higher prevalence in boys is believed to be the result of a referral bias because boys with ADHD are more disruptive and aggressive, and, therefore, more likely to be referred to specialty clinics. ADHD is caused by a combination of biological – often genetically determined neurochemical disturbances – and environmental disadvantages that are associated with learning difficulties, behavioural problems and social rejection. The identification and treatment of children with ADHD are essential in preventing or at least minimizing the serious complications associated with this disorder. Stimulant medications are the most effective means of symptomatic control of ADHD symptoms, and the safety and efficacy of these medications is well established in the literature. Despite the known efficacy of stimulant medications, alternatives are often sought by parents of children with ADHD. A number of alternative and controversial treatments for ADHD are available, including dietary management, nutritional supplementation, vision therapy, hypnotherapy, guided imagery, relaxation training and electroencephalogram (EEG) neurofeedback. Published well controlled scientific studies either to support or refute the effectiveness of EEG neurofeedback for children with ADHD are not available. At the present time, EEG neurofeedback needs to be considered as an experimental treatment, the validity of which has not yet been determined.     

Transmission of primary nocturnal enuresis and attention deficit hyperactivity disorder

Primary nocturnal enuresis (PNE) is a prevalent disorder among children with a complex mode of inheritance. Family, twin, and linkage studies have provided evidence that genetic factors underlie the familiality of PNE. Linkage investigations support the hypothesis that PNE is heterogeneous, and the genetic heterogeneity may be reflected in co-morbid clinical conditions such as attention deficit hyperactivity disorder (ADHD). This study used a family study method and examined the transmission of PNE in relatives of PNE and control probands with and without ADHD, to determine if these disorders co-occur due to common genetic susceptibilities or other, i.e. non-genetic, reasons. This study concluded that the pattern of inheritance found is consistent with the independent transmission of PNE and ADHD.