威斯康星卡片分类测验用于注意缺陷多动障碍的meta分析

目的　分析注意缺陷多动障碍 (ADHD)患儿与正常儿童在威斯康星卡片分类测验 (WCST)中各指标成绩的差异。方法　复习国外 14篇有关文献 ,对ADHD患儿和正常儿童WCST的 4个指标 (持续性错误数、分类完成数、非持续性错误数和持续性反应数 )进行meta分析。结果　ADHD和正常对照组在WCST的持续性错误数、完成分类数和非持续性错误数的成绩差异有统计学意义 ,且可靠性较好。两组的持续性反应数也有统计学意义 ,但其可靠性较差。ADHD患儿的平均持续错误数比正常儿童高 0 4 6倍标准差。正常儿童的平均完成分类数比ADHD组高 0 37倍标准差。ADHD患儿的平均非持续性错误数比正常儿童高 0 37倍标准差。ADHD患儿的平均持续性反应数比正常儿童高 0 30倍标准差。 4个指标的效应尺度均在小至中的范围。结论　WCST值得推广应用于ADHD患儿 ,较敏感的指标包括持续性错误数、完成分类数和非持续性错误数。ADHD患儿可能存在前额叶功能缺陷。

The meta-analysis applied to performance on WCST in patients with attention deficit hyperactivity disorder

Objective To study the performance on WCST in children with attention deficit hyperactivity disorder(ADHD).Methods Fourteen independent investigations on WCST in children with ADHD were selected for meta-analysis,including 4 indices:perseverative errors(PE),categories control(CC),nonperseverative errors(NPE) and perseverative responses(PR) of WCST.Results The performance of PE,CC and NPE on WCST in patients with ADHD was significantly poorer than that of healthy children(The average PE of ADHD patients was 0.46 times standard deviation more than that of healthy children;the average CC of ADHD patients was 0.37 times standard deviation lower than that of healthy children;the average NPE of ADHD patients was 0.37 times standard deviation more than that of healthy children) and was quite reliable.The performance of perseverative responses(PR) on WCST in ADHD patients was significantly poorer than that of healthy children(The average PR of ADHD patients was 0.30 times standard deviation more than that of healthy children) but with poor reliability.The effect sizes of four indices on WCST were in the small to moderate range.Conclusion The WCST is worth being applied to the patients with ADHD.The sensitive indices include PE,CC and NPE.The ADHD may be a brain disorder primarily affecting the prefrontal cortex or the regions projecting to the prefrontal cortex.