哌醋甲酯治疗儿童注意缺陷多动障碍依从性的影响因素分析

Influential factors for methylphenidate treatment compliance in children with attention deficit hyperactivity disorder

摘要:

目的：了解注意缺陷多动障碍（attention deficit hyperactivity disorder, ADHD）患儿接受药物治疗与否及服药依从性好坏的影响因素。方法：以188例符合DSM-Ⅳ诊断标准的首诊ADHD儿童为研究对象，完成相关症状评定及认知功能测试，评估哌醋甲酯治疗的依从性。结果：情绪状态好、较少逆反和多动行为的患儿及有精神疾病家族史、数字划消测验得分低者更倾向服药和（或）有更好的服药依从性。其中，logistic回归分析显示患儿不好动、逆反少、数字划消测验得分低是愿意接受药物治疗的预测因素，情绪状态得分高是服药依从性好的预测因素；注意缺陷为主型患儿较混合型患儿接受服药比例更高且服药依从性更好；而性别、年龄、症状严重程度等因素则并不影响是否接受治疗和（或）服药依从性。结论：要特别重视提高伴多动冲动及逆反行为ADHD患儿的服药依从性，改善患儿长期的社会功能。

Abstract:

OBJECTIVE: To investigate influential factors for the tendency to medicate and medication compliance in children with attention deficit hyperactivity disorder (ADHD). METHODS: A total of 188 children aged from 5 to 16 years, who were initially diagnosed with ADHD according to DSM-IV criteria, were included in the study. They underwent symptom assessment and cognitive function test. The compliance of methylphenidate treatment was evaluated. RESULTS: Patients with better emotional state, and fewer oppositional and hyperactive behaviors and those who had a family history of psychiatric diseases and who obtained lower scores in the number cancellation test (NCT), were more prone to medication and/or exhibited better medication compliance. Logistic regression analysis showed that fewer oppositional and hyperactive behaviors and lower NCT scores were the predictive factors for a higher tendency to medicate, and a better emotional state was the predictive factor for better medication compliance. Patients of predominantly inattentive type were more prone to medication and showed better medication compliance, as compared with those of combined type. Gender, age and symptom severity were not associated with the tendency to medicate and/or medication compliance. CONCLUSIONS: There is a need to enhance medication compliance in children with ADHD who have hyperactive, impulsive and oppositional behaviors, and to improve their long-term social functions.