??????????????748???????????????

目的比较美国《精神障碍诊断与统计手册》第4版(DSM-Ⅳ)注意缺陷多动障碍(ADHD)中以注意障碍为主型(ADHD-I)、以多动/冲动为主型(ADHD-HI)和混合型(ADHD-C)的临床特点。方法将1999年9月至2004年4月北京大学精神卫生研究所门诊就诊的符合DSM-Ⅳ中的ADHD诊断标准者748例分为ADHD-I型398例,ADHD-C亚型307例和ADHD-HI亚型43例,比较3个亚型的共患疾病,以及Rutter和Conners儿童行为问卷(父母问卷)中的行为问题。结果ADHD-C亚型对立违抗性障碍、品行障碍、双相障碍-躁狂发作的共患率显著高于ADHD-I和ADHD-HI亚型(P<0·01);ADHD-I学习困难的共患率显著高于其它两组亚型(P<0·001)。Rutter儿童行为问卷中ADHD-C亚型伴有的总行为问题和A行为问题明显多于ADHD-I与ADHD-HI亚型;ADHD-I亚型伴有的M行为问题多于ADHD-C与ADHD-HI亚型(P≤0·001)。Conners儿童行为问卷中ADHD-C和ADHD-HI亚型出现品行问题、冲动和多动、多动指数问题的比例均高于ADHD-I亚型(P≤0·001)。结论ADHD-C亚型的破坏性行为问题突出,而ADHD-I亚型的学习困难问题明显。

Clinical features of the subtypes of attention deficit hyperactivity disorder in 748 Chinese children

?? To explore the features of three clinical subtypes of attention deficit hyperactivity disorder (ADHD) in Chinese outpatient children. MethodsUsing DSM-?? Structured Clinical Diagnostic Interview Scale(CDIS),the 748 ADHD children were clascified into three subtypes,and identified 398 ADHD-I??307 ADHD-C,and 43 ADHD-HI.We compared the comorbidities in CDIS,the behavioral problems in Rutter and Conners Child Behavior Questionnaire completed by the parents among ADHD three subtypes. ResultsFor ADHD-C subtype,the frequencies of comorbidity with disruptive behavior disorder (oppositional defiant disorder and conduct disorder) and bipolar disorder,and the frequency of A-type behavior in Rutter's scale,were higher than those in the ADHD-I and ADHD-HI subtypes (P<0.01).For ADHD-I subtype,the frequencies of comorbidity with learning disability and M-type behavior in Rutter's scale,were significantly higher than those in the ADHD-C and ADHD-HI subtypes (P<0.001).The frequencies of conduct problems,implusive-hyperactive,and hyperactivity index in ADHD-C and ADHD-HI were greater than that in ADHD-I subtype(P??0.001). ConclusionThere is a higher prevalence of comorbid disruptive behavior disorders in the ADHD-C subtype,but there is a higher prevalence of comorbid learning disability in the ADHD-I subtype.