注意缺陷多动障碍儿童焦虑发生率及其症状特征

Incidence rate of anxiety and characteristics of symptoms in children with attention-deficit hyperactivity disorder

目的:比较注意缺陷多动障碍儿童与正常儿童焦虑检出率及焦虑症状的异同。方法:选择注意缺陷多动障碍组为2004-06/09中南大学湘雅二医院儿童精神科门诊病例中,符合DSM-Ⅳ诊断标准的注意缺陷多动障碍儿童66例,年龄9～14岁,小学三年级及以上文化程度;对照组为性别比例、年龄、文化程度均与注意缺陷多动障碍组儿童相匹配的普通中小学儿童66人。采用儿童焦虑情绪障碍筛查表进行儿童情绪障碍筛查。该量表共41个项目,包括躯体/惊恐、广泛性焦虑、分离性焦虑、社交恐怖、学校恐怖5个因子,采用3级评分:0没有此问题、1有时有、2经常有,由儿童根据最近3个月的情况进行自我评定,得分越高提示焦虑症状越严重。以总分≥23分为存在焦虑情绪障碍的标准。在量表评定过程中,使用统一的指导用语,无记名,量表当场收回。并采用自编一般情况调查表调查儿童一般情况,采用父母问卷调查父母情况(父母职业、父母文化程度)、家庭情况(家庭经济水平),以评价两组儿童的家庭情况是否存在明显差异而影响实验结果。结果:66例注意缺陷多动障碍儿童及对照组正常儿童66人均完成量表测试,全部进入结果分析。①注意缺陷多动障碍组儿童有25人存在焦虑障碍,注意缺陷多动障碍组儿童焦虑检出率显著高于正常对照组(38%,20%,χ2=5.321,P=0.021)。②注意缺陷多动障碍组儿童躯体/惊恐显著高于正常对照组,差异有显著性[(5.61±4.85),(3.71±3.61),t=2.545,P=0.012];广泛性焦虑显著高于正常对照组,差异有显著性[(5.20±3.22),(3.71±3.69),t=2.466,P=0.015];分离性焦虑显著高于正常对照组,差异有显著性[(4.89±3.26),(3.47±2.75),t=2.710,P=0.008];学校恐怖及总分显著高于正常对照组,差异有显著性[(1.47±1.76),(0.88±1.12),t=2.299,P=0.023];[(21.52±12.41),(15.26±10.68),t=3.105,P=0.002]。结论:注意缺陷多动障碍儿童焦虑检出率较高,多伴有躯体/惊恐、广泛性焦虑、分离性焦虑、学校恐怖等焦虑情绪问题。

AIM： To compare the prevalence and the symptoms of anxiety between children with attention-deficit hyperactivity disorder （ADHD） and normal children. METHODS： A total of 66 children with ADHD accorded to the diagnosis standard of DSM-Ⅳ aged 9 to 14 years, education level of 3-grade elementary school or high, who were treated at a psychiatric clinic for children of Xiangya Second Hospital, Central South University from June to September 2004, were selected as ADHD group. Sixty-six normal children were selected as control group by gender, age and education level. Emotional disorder of children was assessed with the screen for child anxiety related emotional disorders （SCARED）, which had 41 items, divided into 5 factors： somatization symptoms, generalized anxiety, separation anxiety, social phobia and school refusal. Every item was graded 3 level： 0 as no, 1 as sometimes, 2 as often. Assessed by children themselves based on their emotions in recent 3 months. Higher Score expressed more anxious emotional problems. Score of 23 points or higher signs to anxiety disorder. Use the same instruction, anonymity and the scale was taken back on the spot. General conditions of children were surveyed with self-made general condition inventory. Condition of parents （occupation, education level and family economy） was assessed with parents ＇questionnaire to compare the apparent difference of complexion of the parents of children in the two groups. RESULTS： Totally 66 ADHD children and 66 normal children in the control group were done the test and involved in the result analysis. （!） Twenty-five children in the ADHD group had anxiety disorder, and the prevalence of anxiety of children in the ADHD group was higher obviously than that in the normal control group （38% ,20% X^2=5.321 ,P=0.021 ）. The score on somatization symptoms of children in the ADHD group was higher markedly than that in the normal control group with significant difference [（5.61±4.85）, （3.71±3.61）,t=2.545,P=0.012]. The score on generalized anxiety was higher remarkably than that in the normal control group with significant difference [（5.20±3.22）, （3.71±3.69）,t=2.466,P =0.015]. The score on separation anxiety was higher distinctly than that in the normal control group with significant difference [（4.89±3.26）, （3.47 ±2.75） ,t=2.710,P=0.008]. The scores on school refusal and the total score were higher evidently than that in the normal control group with significant difference [ （ 1.47 ± 1.76 ）, （ 0.88 ± 1.12 ）, t =2.299, P=0.023] ; [ （ 21.52 ±12.41 ）, （ 15.26± 10.68 ）, t=3.105, P=-0.002]. CONCLUSION： The prevalence of anxiety in children with ADHD is higher, and often with many anxious emotional problems： sonaatization symptoms, generalized anxiety, separation anxiety, and school refusal, etc.