儿童注意缺陷多动障碍共患对立违抗性障碍的危险因素研究

目的:探讨儿童注意缺陷多动障碍(ADHD)共患对立违抗性障碍(ODD)的危险因素.方法:以符合美国《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)诊断标准,并按照性别、年龄及ADHD亚型匹配的单纯ADHD及ADHD共患ODD儿童各43例为研究对象,由家长填写健康史、生活环境及家族史等.比较两组间在各变量上的差异,以ADHD+ODD诊断为因变量,以两组间差异有统计学意义的变量作为自变量,用向后删除法作Logistic回归分析.结果:(1) ADHD+ODD组与ADHD组患儿相比,精神病阳性家族史(16% vs 2%,P＝0.058,OR=8.167)、父母长期冲突(23% vs 7%,P＝0.035,OR=4.040)、有持久而严厉的父母训导(51% vs 28%,P＝0.027,OR=2.706)的比例高;ADHD+ODD组患儿出生时缺氧/青紫的比例低于ADHD组(0 vs 12%,P＝0.055,OR=0.469).(2)经两步筛选,保留在模型中的自变量有1个,即持久而严厉的父母训导(P＝0.054,OR=2.879).回归方程的灵敏度为53.5%,特异度为83.7%,总正确率为68.6%.结论:教育方式不当是ADHD共患ODD的危险因素.父母长期冲突和精神病阳性家族史也可能对ADHD共患ODD产生影响.

Risk factors of attention deficit hyperactivity disorder comorbid with oppositional defiant disorder in children

OBJECTIVE: To explore risk factors of attention deficit hyperactivity disorder (ADHD) comorbid with oppositional defiant disorder (ODD) in children. METHODS: parents of 43 pure ADHD+ODD children, and 43 pure ADHD children (criteria of DSM-IV; group matched by sex, age and ADHD subtypes) were asked to complete a set of investigation questionnaires including child and family information; family history; pregnancy, delivery and infancy complications; physical development and temperament; and predisposing factors and parents' or teachers' responses toward children's misbehaviors. RESULTS: probabilities of psychosis or schizophrenia of family members, long-term conflict between parents and parents' constant/stringent criticism to children in ADHD+ODD group were significantly higher than those in ADHD group (psychosis or schizophrenia of family members (16% vs 2%, P=0.058, OR=8.167); long-term conflict between parents (23% vs 7%, P=0.035, OR=4.040); parents' constant/stringent criticism to children (51% vs 28%, P=0.027, OR=2.706); probability of having anoxia at birth in ADHD group was significantly higher than that in ADHD+ODD group (12% vs 0, P=0.055, OR=0.469). Setting diagnosis of ADHD+ODD as dependent variable, and factors with significant difference between the two groups as independent variables, after 2 steps of regression analyses, one factor, i.e. parents' constant/stringent criticism to children was left in the model (P=0.054, OR=2.879). The regression formula had a sensitivity of 53.5%, a specificity of 83.7%, and total correction rate of 68.6%. CONCLUSION: Inappropriate parenting is a risk factor of ADHD comorbid with ODD, and long-term conflict between parents and positive family history of psychoses might have influence on ADHD comorbid with ODD.