不同诊断标准的多动症患者临床特点比较

DSM-IV and ICD-10: A Comparison of Clinical Features of Attention Deficit-Hyperactivity Disorder and Hyperkinetic Disorder

目的:比较美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)和国际疾病分类第10版(ICD-10)诊断为多动症患儿的临床特征,以期为临床上选用何种诊断标准提供参考。方法:对516例门诊就诊的多动症患儿进行研究,以儿童临床诊断性会谈量表与父母进行定式访谈,仅符合DSM-Ⅳ的317例组成ADHD组(注意缺陷多动障碍,attention deficit-hyperactivity disorder,ADHD),同时符合两种诊断标准的199例组成HKD-ADHD组(多动性障碍,hyperkinetic disorder,HKD)。结果:HKD-ADHD组以混合型为主(75.4%),ADHD组患者以注意缺陷型为主(67.2%);前者较后者起病和就诊年龄早,共患品行问题、对立违抗障碍和感觉统合失调多(P均<0.05);后者在低年龄段共患学习困难多(P<0.05)。结论:HKD较ADHD患者临床症状更严重,但仅符合DSM-Ⅳ标准的患者较一般儿童在学习、行为方面已出现一些功能损害,因此在临床中推荐采用DSM-Ⅳ标准,以使患者能得到早期诊治。

Objective: To examine the differences on clinical features between DSM-Ⅳ ADHD and ICD-10 HKD patients. Methods:516 children referred to psychiatric clinic because of overactivity, inattention, and impulsivity symptoms were divided into two groups: Children meeting both criteria ( HKD-ADHD group, n=199), and children meeting only DSM-Ⅳ ADHD criteria (ADHD group, n=317). Diagnoses were confirmed by structured interview with parents using Clinical Diagnostic Interview Scale. Results: Whereas the combined type is predominant in HKD-ADHD group (75.4%), predominately inattentive type take account of the majority in ADHD group (67.2%). Compared to ADHD group, HKD-ADHD group includes the patients with younger referral age(9.6±2.2 vs 10.7±2.6) and earlier onset of age(4.6±1.9 vs 5.9±2.5), more opposite defiant disorder comorbidity (41.2% vs 26.2%), more disturbed behaviors, and higher sensory integrative dysfunction prevalence (72.6% vs 56.9% ). However, among the patients not older than 9-year-old there is higher prevalence of learning disability in ADHD group (26.7% vs 14.8%).Conclusion: ICD-10 criteria identified a severe group of patients than those identified by DSM-Ⅳ.However, the patients satisfied only DSM-Ⅳcriteria has exhibited more academic difficulty and behavioral disturbance compared with normal children, so we recommend DSM-Ⅳ as clinical diagnostic tool so that earlier interventions could be possible.