注意缺陷多动障碍儿童与正常儿童平衡功能发育特点比较

Comparison of postural control between normal and attention deficit hyperactivity disorder boys

目的:探讨注意缺陷多动障碍(ADHD)男孩以及对照儿童的平衡功能发育特点。方法:采用美国Neuro-Com公司的平衡仪,以146例符合ADHD诊断的男孩及84名正常对照男孩(年龄在7～12岁)为研究研究对象,测试其静态平衡功能。结果:(1)正常男孩:发现在固定平面闭眼和海绵垫平面闭眼状态下存在组间差异,差异具有统计学意义。在固定平面睁眼条件下各相邻年龄组间差异无统计学意义,但11～12岁组仍差于成人水平,差异有统计学意义(t=6.145,P<0.001);在固定平面闭眼和海绵垫平面睁眼状态下7～8岁组与9～10岁组,差异具有统计学意义[固定平面闭眼7～8岁组为(0.65±0.35)°/s,9～10岁组为(0.45±0.19)°/s,P<0.05;海绵垫平面睁眼7～8岁组为(0.98±0.38)°/s,9～10岁组为(0.80±0.25)°/s,P<0.05];11～12岁组仍差于成人水平,差异有统计学意义((t值分别为5.059,6.203,P<0.001);在海绵垫平面闭眼状态下7～8岁组与9～10岁组,差异具有统计学意义[7～8岁组为(1.65±0.58)°/s,9～10岁组为(1.34±0.42)°/s,P<0.05]。11～12岁组与成人比较差异无统计学意义。(2)ADHD男孩:在四种测试状态下7～8岁组与9～10岁组差异具有统计学意义[固定平面睁眼7～8岁组为(0.81±0.31)°/s,9～10岁组为(0.63±0.28)°/s,P<0.01;固定平面闭眼7～8岁组为(0.91±0.46)°/s,9～10岁组为(0.70±0.49)°/s,P<0.05;海绵垫平面睁眼7～8岁组为(1.31±0.56)°/s,9～10岁组为(1.10±0.43)°/s,P<0.05;海绵垫平面闭眼7-8岁组为(2.19±0.88)°/s,9～10岁组为(1.85±0.78)°/s,P<0.05],9～10岁组与11～12岁组,差异具有统计学意义[固定平面睁眼9～10岁组为(0.63±0.28)°/s,11～12岁组为(0.46±0.21)°/s,P<0.01;固定平面闭眼9～10岁组为(0.70±0.49)°/s,11～12岁组为(0.47±0.31)°/s,P<0.01;海绵垫平面睁眼9～10岁组为(1.10±0.43)°/s,11～12岁组为(0.83±0.27)°/s,P<0.001;海绵垫平面闭眼9～10岁组为(1.85±0.78)°/s,11～12岁组为(1.44±0.56)°/s,P<0.01]。(3)ADHD男孩与正常男孩不同年龄阶段姿势发育比较:在7-8岁组在固定平面睁眼状态下ADHD男孩平均摇摆速率大于正常儿童,差异具有统计学意义(t=2.700,P<0.05),9～10岁组在四种测试条件下ADHD男孩平均摇摆速率均大于正常儿童,差异具有统计学意义(四种状态下t值分别为2.968,2.982,3.851,3.629,四种状态下P<0.05)。结论:平衡功能在儿童学龄阶段仍在发展,11～12岁时尚未达到成人水平。ADHD男孩平衡功能随年龄增长而发展但落后于正常男孩,在青春期前发展快。

Objective：To examine postural control between normal and attention deficit hyperactivity disorder（ADHD）boys,and compare the development characters.Methods：In the study,146 ADHD boys and 84 normal boys participated,ages being between 7 and 12 years.Balance Master was used to assess posture control.Posture stabilities were tested under 4 different conditions（firm surface with eyes open,firm surface with eyes closed,foam pad with eyes open,foam pad with eyes closed）.We tested three times for one condition,20 s per time.The mean sway velocity was recorded.Results：（1）Normal boys：In firm surface with eyes open,analyses of variance between normal boys revealed no significant differences between different age groups,and the 11-and 12-year-old group did not achieve scores comparable to the adult（t=6.145,P〈0.001）.In firm surface with eyes closed and,foam pad with eyes open analyses revealed significant differences between the 7-and 8-year-old and 9-and 10-year-old groups[firm surface with eyes closed,7-and 8-year-old（0.65±0.35）°/s,9-and 10-year-old（0.45±0.19）°/s,P〈0.05 ;foam pad with eyes open,7-and 8-year-old（0.98±0.38）°/s,9-and 10-year-old（0.80±0.25）°/s,P〈0.05];and the 11-and 12-year-old group did not achieve scores comparable to the adult（t=5.059,6.206,P〈0.001）.In foam pad with eyes closed,analyses revealed significant differences between 7-and 8-year-old and 9-and 10-year-old groups[7-and 8-year-old（1.65±0.58）°/s,9-and 10-year-old（1.34±0.42）°/s,P〈0.05],the 11-and 12-year-old group achieving scores comparable to the adult.（2）ADHD boys：Analyses of variance between ADHD boys,under the four different conditions,revealed significant differences between 7-and 8-year-old and 9-and 10-year-old[firm surface with eyes open,7-and 8-year-old（0.81±0.31）°/s,9-and 10-year-old（0.63±0.28）°/s,P〈0.01;firm surface with eyes close,7-and 8-year-old（0.91±0.46）°/s,9-and 10-year-old（0.70±0.49）°/s,P〈0.05;foam pad with eyes open,7-and 8-year-old（1.31±0.56）°/s,9-and 10-year-old（1.10±0.43）°/s,P〈0.05;foam pad with eyes close,7-and 8-year-old（2.19±0.88）°/s,9-and 10-year-old（1.85±0.78）°/s,P〈0.05],and also significant differences between 9-and 10-year-old and 11-and 12-year-old groups[firm surface with eyes open,9-and 10-year-old（0.63±0.28）°/s,11-and 12-year-old（0.46±0.21）°/s,P〈0.01;firm surface with eyes close,9-and 10-year-old（0.70±0.49）°/s,11-and 12-year-old（0.47±0.31）°/s,P〈0.01;foam pad with eyes open,9-and 10-year-old（1.10±0.43）°/s,11-and 12-year-old（0.83±0.27）°/s,P〈0.001;foam pad with eyes close,9-and 10-year-old（1.85±0.78）°/s,11-and 12-year-old（1.44±0.56）°/s,P〈0.01].（3）Comparison of postural control between normal and ADHD boys：In firm surface with eyes open,analyses revealed the 7-and 8-year-old group swayed higher in ADHD group than in normal control（t=2.700,P〈0.05）,in the other three conditions there was a significant tendency.In the four conditions,the 9-and 10-year-old group swayed higher in ADHD group than in normal control（t=2.968,2.982,3.851,3.629,P〈0.05）Conclusion ：These results suggest that children do not demonstrate adult-like use of sensory information at the ages of 11and 12 years.ADHD boys have a lower posture control ability than normal boys.