不同亚型注意力缺陷多动障碍患儿的临床特征分析

Clinical features of various subtypes of attention deficit hyperactivity disorders in children

摘要:

目的：研究不同亚型注意力缺陷多动障碍(ADHD)患儿的临床特征。方法：将符合美国《精神障碍诊断与统计手册(第4版)》ADHD诊断标准的175名患儿，分为注意缺陷型（ADHD-I，n=82）、多动-冲动型（ADHD-HI，n=24）和混合型（ADHD-C，n=69），分别进行性别构成、危险因素、共患疾病、智力水平和Conners父母症状问卷的比较。结果：各亚型男女性别构成差异无统计学意义；ADHD-I组和ADHD-C组分娩异常的比率高于ADHD-HI组，ADHD-HI组和ADHD-C组家庭教育方式不当的比率高于ADHD-I组；3组言语智商、操作智商和总智商差异无统计学意义，ADHD-I组智力发展不平衡比率高于其他两组；ADHD-HI组和ADHD-C组对立违抗障碍、抽动障碍的共患率高于ADHD-I组，ADHD-I组和ADHD-C组学习困难的共患率高于ADHD-HI组；ADHD-HI组和ADHD-C组品行问题、冲动-多动、多动指数均高于ADHD-I组，而ADHD-I组学习问题最显著。结论：ADHD-C和ADHD-HI患儿对立违抗障碍和抽动障碍共患率较高，多动-冲动等破环性行为突出，ADHD-I患儿学习问题和智力发展不平衡显著。［中国当代儿科杂志，2010，12（9）：704-708］

Abstract:

OBJECTIVE: To study the features of various subtypes of attention deficit hyperactivity disorders (ADHD) in children. METHODS: Sex composition, risk factors, comorbidities, intelligence quotient and behavioral problems were investigated in 175 children with ADHD who met the Diagnostic Statistical Manual of Mental Disorder Criteria (DSM-IV). The children were classified into three groups: ADHD predominantly inattentive (ADHD-I, n=82), ADHD predominantly hyperactive-impulsive (ADHD-HI, n=24) and ADHD combined type (ADHD-C, n=69). RESULTS: There were no significant differences in the sex composition among the three groups. The rates of birth abnormality in the ADHD-I and the ADHD-C groups were higher than those in the ADHD-HI group. Negative parenting practices were noted more frequently in the ADHD-HI and the ADHD-C groups than the ADHD-I group. There were no significant differences in the performance intelligence quotient (PIQ), verbal intelligence quotient (VIQ) and full intelligence quotient (FIQ) among the three groups. However, the incidence of imbalance between VIQ and PIQ in the ADHD-I group was higher than the other two groups. The rate of comorbidities with oppositional defiant disorder (ODD) and tic disorder (TD) in the ADHD-C and the ADHD-HI groups was higher than that in the ADHD-I group. Both the ADHD-I and the ADHD-C groups had a higher rate of comorbidities with learning disorder (LD) than the ADHD-HI group. The implusive/hyperactive and conduct problems were more severe and the hyperactivity index was higher in the ADHD-C and the ADHD-HI groups than those in the ADHD-I group, while the learning difficulties in the ADHD-I group were the most severe. CONCLUSIONS: The children with ADHD-C or ADHD-HI have higher incidences of comorbidities with ODD and TD than those with ADHD-I who the learning difficulties and the imbalance between VIQ and PIQ are more severe.［Chin J Contemp Pediatr, 2010, 12 (9):704-708］