注意缺陷多动障碍儿童执行功能的评估与干预

Evaluation and intervention of hot- and cool-executive function in children with attention deficit hyperactivity disorder

ADHD儿童认知障碍的主要特征之一是执行功能损害,涉及包括前额叶皮层在内的特定脑区域及多层级脑网络异常。执行功能按照功能性分为冷-热两方面:冷执行功能损害主要表现于反应抑制、工作记忆以及认知灵活性等;热执行功能损害通常涉及延迟满足、赏罚相关决策、自我调节及情绪调节等。ADHD儿童的执行功能评估应基于可信范式进行文化适应性调整。临床干预不能单一聚焦于冷执行功能,需关注儿童的身体发育以及热执行功能(情绪社会方面)的发展进程,结合其他共病与心理状况,进行全面的动态随访与干预,以达到最佳的长期疗效。

Executive function impairment emerges as a primary cognitive deficit in children with attention deficit hyperactivity disorder(ADHD),involving prefrontal cortex and multi-level brain network dysfunction.Executive function has been functionally classified into cool and hot.Cool-executive function impairment mainly manifests in response inhibition,working memory and cognitive flexibility,while hot-executive function impairment usually involves delayed gratification,reward/punishment-related decision-making,self-regulation and emotion regulation.A variety of traditional paradigms have been used when assessing executive function in ADHD children,some of which are reliably modified and culturally adapted.Based on the literature,clinical practice should not focus exclusively on cool executive function.Children′s impairment in hot executive function(with emotional and social components)should also be noted as significant indicators when evaluating the state of children′s condition.Additionally,dynamic follow-up and intervention should be required to achieve the best results in the long term.