伴与不伴前庭功能失调的注意缺陷多动障碍患儿临床特点的对照研究

Clinical characters of attention deficit hyperactivity disorder children with and without vestibular dysfunction: a case-control study

目的 探讨伴与不伴前庭功能失调的注意缺陷多动障碍(ADHD)患儿的临床特点。方法 使用儿童感觉统合能力发展评定量表,将符合美国精神障碍诊断与统计手册第4版诊断标准的255例ADHD患儿经严格年龄配对后,分为伴轻度前庭功能失调、伴重度前庭功能失调和不伴前庭功能失调三组(每组各85例),对其临床症状及行为特点进行分析。结果 (1)症状学检测,与不伴前庭功能失调组比较,伴前庭功能失调两组在核心症状中的多动冲动症状评分高(P<0.01);在临床亚型分布中注意缺陷型的比例低,混合型的比例高(均P<0.01);在社会功能损害中伙伴关系受损的比例高(P<0.01)。(2)行为学检测,伴前庭功能失调两组的Rutter量表总分、Conners量表和Achenbach患儿行为问卷的异常率均高于不伴前庭功能失调组,其中伴重度前庭功能失调组的攻击分量表异常率高于不伴前庭功能失调组和伴轻度前庭功能失调组(P<0.01)。结论 伴前庭功能失调的ADHD患儿伴发行为问题多,临床分型中多为混合型;不伴前庭功能失调的ADHD患儿临床分型多为注意缺陷型。是否伴有前庭功能失调及其严重程度能影响ADHD患儿临床症状和行为特点的分布。

Objective To study the clinical characters of the attention deficit hyperactivity disorder (ADHD) children with or without vestibular dysfunction. Methods All participated 255 ADHD children were classified into three subgroups according to the Child Sensory Integration Check Scale, i. e. , ADHD without vestibular dysfunction, ADHD with mild vestibular dysfunction, and ADHD with severe vestibular dysfunction. The clinical symptoms and behavior characters were compared between the subgroups. Results The general scores of hyperactivity-impulsive symptoms on Clinical Diagnostic Interview Scale (CDIS) in children with mild and severe vestibular dysfunction were significantly higher than that in children without vestibular dysfunction ( P < 0. 01 ). The percentage of ADHD-Inattentive type in children with mild and severe vestibular dysfunction was less than that in ADHD children without (P <0. 01) , while the subtype of ADHD-Combined was predominant in ADHD children with mild and severe vestibular dysfunction (P < 0. 01). The partner fellowships were impaired more severely in ADHD children with vestibular dysfunction comparing with that without vestibular dysfunction ( P < 0. 01 ) . The frequencies of abnormal total score of Rutter Scale and hyperactivity index of Conner's Scale were higher in children with severe vestibular dysfunction than that in those without ( P < 0. 01, P < 0. 05 ) . In children with mild and severe vestibular dysfunction, the frequency of abnormal hyperactivity subscale score in Achenbach Children Behavior Questionnaire was more than that those without ( P < 0. 01). The frequency of abnormal aggressive subscale score of children with severe vestibular dysfunction was higher than that of those with mild and without vestibular dysfunction (P < 0. 01 ). Conclusion The clinical characters of the ADHD children with vestibular dysfunction include companying more behavior problems, especially hyperactivity, aggression, disobey, getting angry, and notable impairment of relationship with peer. The severity degree of the vestibular dysfunction accompanying ADHD will influence the distributing of the core symptom of ADHD.