不同亚型注意缺陷多动障碍儿童家庭环境与行为比较

目的 对注意缺陷多动障碍(ADHD)常见亚型的家庭环境与冲突处理能力进行比较,寻求ADHD行为问题的危险因素,探讨不同亚型认知损伤的差异.方法 选择ADHD注意缺陷型(ADHD-Ⅰ型)和混合型(ADHD-C型)各39例、正常儿童38名,进行Conners父母问卷(PSQ)、家庭环境量表(FES-CV)的评定和空间整合Simon-Stroop任务的完成.结果 1.量表:①PSQ:ADHD-Ⅰ型和ADHD-C型的品行问题[(0.65±0.32)分,(1.05±0.44)分]、学习问题[(1.58±0.58)分,(1.97±0.52)分]、冲动-多动[(1.06±0.46)分,(1.56±0.60)分]及多动指数[(1.01±0.31)分,(1.45±0.40)分]与正常组[(0.42±0.24)分,(0.77±0.49)分,(0.58±0.40)分,(0.55±0.34)分]比较,差异有统计学意义(P＜0.05)；两亚型间上述4个评分差异有统计学意义；②FES-CV:ADHD-Ⅰ型和ADHD-C型的亲密度[(6.75±2.27)分,(6.61±2.03)分]、情感表达[(5.03±1.54)分,(5.06±1.91)分]、矛盾性[(3.28±1.70)分,(4.61±2.56)分]、知识性[(3.83±2.30)分,(3.61±1.81)分]、娱乐性[(3.70±2.12)分,(3.47±2.32)分]、控制性[(4.78±2.23)分,(4.81±2.07)分]与正常组[(8.06±1.71)分,(6.03±1.54)分,(2.36±1.44)分,(4.86±1.91)分,(4.83±2.29)分,(3.67±1.90)分]比较,差异有统计学意义(P＜0.05)；两亚型间矛盾性评分差异有统计学意义.2.行为学:Simon不一致(Siin)和Stroop不一致(Stin)条件,ADHD-Ⅰ型和ADHD-C型的反应正确率(Siin:0.76±0.13,0.69±0.13；Stin:0.82±0.10,0.78±0.08)和反应时[Siin( 876.4±97.34) ms,( 893.8±130.1) ms；Stin(864.4±91.82) ms,(860.2±125.0) ms]与正常组[Siin(0.81 ±0.11)ms,(810.4±136.1) ms；Stin(0.87±0.08) ms,(797.4±136.1 )ms]比较,差异有统计学意义(P＜0.05)；两亚型间Siin及Stin的正确率差异有统计学意义.3.Pearson相关分析:FES-CV某些环境因素与ADHD儿童的行为特点存在不同程度相关性.结论 不良的家庭环境是ADHD儿童发生行为问题的危险因素,且ADHD-C型的家庭、行为问题较ADHD-Ⅰ型突出.ADHD两亚型均存在冲突信息的处理能力不足,损害程度有所不同,ADHD-C型较ADHD-Ⅰ型重.

Family environment and behavioral study of different subtypes of attention deficit hyperactivity disorder in children

Objective To investigate the risk factors which indicate behavior problems and degree of conflict function defects in different subtypes of attention deficit hyperactivity disorder( ADHD),and to compare behavioral problems,family environment and conflict function in children with and without ADHD.Methods 87children with ADHD and 38 matched controls performed Simon-Stroop task while questionnaires (Parent Symptom Questionnaire and Family environment Scale)were acquired from their parents.Results Questionnaire indicated that children with ADHD-combined(ADHD-C) had the highest score of conduct problem( 1.05 ± 0.44),learning problem ( 1.97 ± 0.52 ),hyperactivity-impulsion ( 1.56 ± 0.60) and hyperactivity index ( 1.45 ± 0.40 ) than ADHDⅠ(0.65±0.32,1.58 ±0.58,1.06 ±0.46,1.01 ±0.31) and matched controls ( 0.42 ±0.24,0.77 ±0.49,0.58±0.40,0.55 ±0.34) in PSQ.ADHD-Ⅰ and ADHD-C had higher score of contradiction(3.28 ± 1.70,4.61 ±2.56 ) and lower score of family cohesion (6.75 ± 2.27,6.61 ± 2.03 ),emotional expression (5.03 ± 1.54,5.06 ±1.91 ),knowledge (3.83 ± 2.30,3.61 ± 1.81 ) and entertainment (3.70 ± 2.12,3.47 ± 2.32 ) than matched controls (2.36 ± 1.44,8.06 ± 1.71,6.03 ± 1.54,4.86 ± 1.91,4.83 ± 2.29) in FES-CV.Behavior data indicated that the correct rate of children with ADHD-Ⅰ and ADHD-C in Simon-incongruent trials( Siin:0.76 ± 0.13,0.69 ±0.13 ) and Stroop-inconsistent trials( Stin:0.82 ± 0.10,0.78 ± 0.08 )were lower and reaction time of children with ADHD-Ⅰ and ADHD-C in the Siin ( (876.4 ± 97.34) ms,( 893.8 ± 130.1 ) ms) and Stin ( ( 864.4 ± 91.82 ) ms,(860.2 ± 125.0) ms) were longer than matched controls ( (Siin (0.81 ± 0.11 ) ms,(810.4 ± 136.1 ) ms; Stin (0.87 ± 0.08 ) ms,(797.4 ± 136.1 ) ms).Pearson correlation analysis suggested that some factors in the FES-CV had correlation with behavioral problems.Conclusion This finding indicates that poor family environment is the risk factor that indicate behavioral problems in children with ADHD and behavioral problems,conflict function defeet of ADHD-C are more serious than ADHD-Ⅰ and matched controls.