儿童对立违抗性障碍、品行障碍和注意缺陷多动障碍中精神病态特质分析

Analysis of psychopathy in children with oppositional defiant disorder, conduct disorder, and attention-deficit hyperactivity disorder

目的分析精神病态特质在品行障碍(CD)、对立违抗性障碍(ODD)和注意缺陷多动障碍(ADHD)儿童青少年中的发生情况,探讨与区分两类障碍有关的病理机制。方法采用反社会性加工筛查表(APSD)对213名儿童青少年进行评估,并对冷漠无情、自恋和冲动特质的得分进行组间比较。结果①ADHD、ODD/CD和ADHD共患ODD/CD三组中冷漠无情特质得分均显著高于对照组(P【0.05);自恋特质在ADHD共患ODD组中得分显著高于其他组(P【0.05),ODD组中得分亦显著高于对照组(P【0.05);三组的冲动特质得分均显著高于对照组(P【0.05)。②三种特质的比例在ADHD共患ODD/CD组中最高(均≥75%),共存的比例】60%,而在对照组中均为较低水平。冷漠无情特质的比例,约为对照组的3倍;自恋特质的比例,在ODD/CD、ADHD共患ODD/CD组中较高(】70%),为ADHD组2.4~2.8倍,对照组4~5倍;冲动特质的比例,三组分别为对照组的2~3倍。自恋特质所造成ODD/CD和共患病与对照组、ADHD组的差异最大。结论冷漠无情特质是ADHD和ODD/CD儿童普遍具有的特质,自恋特质对于CD/ODD儿童具有较高的特异性,冷漠无情、自恋和冲动特质对评估儿童为正常、单纯ADHD或共患CD/ODD的可能性有较高的临床价值。

Objective To analyze the characteristics of the psychopathic traits in children and adolescents with conduct disorder( CD), oppositional defiant disorder( ODD) and attention-deficit hyperactivity disorder(ADHD), and explore the related pathological mechanism between the two disorders. Methods Antisocial Process Screening Device( APSD) was employed in the assessment of 213 children and adolescents, and the scores of callous and unemotion, narcissism and impulsivity were compared among groups. Results ① The scores of callous and unemotion in three groups of ADHD, ODD/CD and ADHD + ODD/CD were significantly higher than that in control group(P < 0.05). The score of narcissism in ADHD + ODD group was significantly higher than those in other groups(P < 0.05), and the score of narcissism in ODD group was also significantly higher than that in control group(P < 0.05). The scores of impulsivity in three groups were significantly higher than that in control group(P < 0.05). ② The proportions of all the three traits were highest in ADHD + ODD/CD group( ≥ 75% for all), and the proportions of coexistence were more than 60%, while those were lower in control group. The proportions of callous and unemotion in three groups were about 3 times that in control group. The proportions of narcissism were at the higher level in ODD/CD group and ADHD + ODD/CD group( > 70%), which were 2.4 to 2.8 times that in ADHD group and 4 to 5 times that in control group. The proportions of impulsivity in three groups were 2 to 3 times that in control group. The differences caused by narcissism in ODD/CD + ADHD group were the largest as compared with control group and ADHD group. Conclusion Callous and unemotion is one of the common psychopathic traits in children with ADHD and ODD/CD, while narcissism has higher specificity for the children with ODD/CD. The measurement of psychopathy has a high clinical value in evaluating whether the child is normal, pure ADHD or ADHD + CD/ODD.