共患学习困难的注意缺陷多动障碍男孩的执行功能特点

Executive function characteristic in boys with attention deficit hyperactivity disorder comorbid learning disabilities

目的:探讨共患学习困难(LD)的注意缺陷多动障碍(ADHD)男孩的执行功能特点。方法:以年龄、ADHD亚型相匹配的符合美国《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)诊断标准的ADHD共患LD,单纯ADHD和正常对照各22例男孩为研究对象,采用Stroop色词命名、Rey复杂图形记忆、数字广度、连线测试、汉诺塔和言语流畅性任务,对研究对象执行功能的各个层面进行评估。结果:(1)两病例组在数字字母连线时间及错误数、转换耗时,言语流畅性重复数的测验成绩均明显比正常对照组差,但两病例组之间的差异无统计学意义。(2)共患组在Stroop1试和2试的耗时及错误数、4试耗时、字义干扰时,Rey复杂图形即时记忆和延迟回忆的细节得分,数字连线时间,汉诺塔犯规次数的测验成绩均明显比正常对照组差。(3)共患组和单纯组在Stroop4试的错误数显著多于正常组,且共患组的错误数显著多于单纯组。结论:单纯ADHD组和ADHD共患LD组与正常儿童相比,在反应抑制、工作记忆、定势切换和言语流畅性的执行功能层面上存在明显受损;共患LD组与单纯ADHD组相比,其执行功能受损的范围更广、程度更重。

Objective：To study the executive function（EF）characteristics in boys with attention deficit hyperactivity disorder（ADHD）comorbid learning disabilities（LD）.Methods：A total of 22 pure ADHD boys,22 ADHD ＋ LD boys and 22 normal controls（by criteria of DSM-Ⅳ）were collected as our samples.The groups were matched by ages（less than 6 months）and ADHD subtypes.The research instruments included the Stroop color-word task,Rey complex figure test,digit span test,trail making test,tower of Hanoi and verbal fluency test.Results：The differences of VIQ weren＇t significant among the three groups;pure ADHD and ADHD＋LD groups had lower PIQ than the control group;ADHD＋LD boys had lower IQ than the controls.The performance in the EF tests：（1）Both pure ADHD and ADHD＋LD groups performed worse in the aspects of time of number-letter part and shifting time,the repeat response of verbal fluency,and the differences were significant.But the differences between ADHD and ADHD＋LD weren＇t significant.（2）ADHD＋LD group also showed deficits in the aspects of time and errors of Stroops 2 and 4,time of Stroop 4,word interference time,the immediate memory and delayed recalling detail score of Rey complex figure test,time of number trail making,error steps（rule violation）of Tow of Hanoi,and the differences were significant.（3）Both ADHD＋LD and pure ADHD groups made more errors in the naming color of the color-word card（Stroop part 4）,and ADHD＋LD boys performed worse than pure ADHD boys.Conclusion：The findings support the hypothesis that ADHD is related to EF deficit,whether or not comorbid LD.ADHD＋LD showed significant difference in the aspects of inhibition,working memory,set shifting and fluency as compared with normal group,ADHD＋LD boys perform more poorly than the pure ADHD boys.It＇s plausible that both ADHD and LD are associated with deficits of executive function.