注意缺陷多动障碍共患病的年龄特征

Comorbidity of attention deficit hyperactivity disorder in different age group

目的:在较大样本中分析注意缺陷多动障碍(ADHD)患者的共患病的年龄分布规律及其特征。方法:采用半定式临床诊断性会谈量表,对1 002例门诊ADHD患者的精神障碍现患情况进行横断面调查,比较不同年龄组患者共患率的差异。结果:各年龄段ADHD患者所患有的破坏性行为障碍(DBD)、心境障碍、抽动障碍和学习困难的共患率差异有统计学意义。(1)DBD和心境障碍:12～14岁组的共患率(分别为124例,51.5%;18例,7.5%)明显高于6～8岁组(分别为160例,41.7%;9例,2.3%;P<0.05);15～17岁组的共患率(分别为29例,72.5%;8例,20.0%)明显高于其他各年龄组(P<0.05)。(2)抽动障碍:12～14岁组的共患率(50例,20.8%)与12岁以下的两个年龄组(6～8岁组51例,13.4%;9～11岁组42例,12.5%)相比差异均有统计学意义(P<0.05)。(3)学习困难:随着年龄的增大,学习困难的共患率逐渐增高,9～11岁组的共患率(106例,31.5%)明显高于6～8岁组(80例,20.9%;P<0.01),12岁以上的两个年龄组的共患率(12～14岁组164例,68.0%;15～17岁组28例,70.0%)均显著高于12岁以下的两个年龄组(P<0.01)。(4)无共患病者:12岁以上的两个年龄组中,无共患病的ADHD患者(12～14岁组29例,12.0%;15～17岁组4例,10.0%)均明显少于12岁以下的两个年龄组(6～8岁组126例,32.8%;9～11岁组110例,32.6%;P<0.01)。在男孩中上述年龄特征仍然存在。结论:ADHD患者进入青春期后的各种心理障碍增多,在青春期后期,这一状况更加严重。

Objective： To study age distribution of attention deficit hyperactivity disorder （ADHD） comorbidities in a relatively large sample, and exam the hypothesis of bad prognosis for ADHD. Methods： Using semi-structured clinical diagnosis interview scale, we investigated comorbidities of 1 002 ADHD children and adolescents from psychiatric out-patient clinic, and compared comorbidity frequency in 4 age groups. Results： The comorbidity frequencies of disruptive behavior disorder （DBD）, mood disorder, tics disorder and learning disorder （LD） in different age groups of ADHD patients differed significantly （P 〈0.01 ）. DBD and mood disorder in the age group of 12 -14 years （124 cases,51.5%;18 cases, 7.5%, respectively） were more than those in the 6 - 8 years group （ 160 cases,41.7% ;9 cases,2.3%, respectively; P 〈0.05 ）. And the comorbidity frequencies of the 15 -17 years group were significantly higher than those in other age groups （P 〈0.05）. Tics disorder in the 12 -14 years group （50 cases, 20.8% ）was more than those in the two age groups of less than 12 years group （for the 6 -8 years group, 51 cases, 13.4% ; for the 9 - 11 years group , 42 cases, 12.5% ; P 〈 0.05 ）. The comorbidity frequency of learning disorder grew up with age. The comorbidity frequency of the 9 - 11 years group （ 106 cases, 31.5% ） was significantly higher than that of the 6 -8 years group （80 cases,20.9% P〈0.01） ; and those of both age groups more than 12 years （for the 12 -14 years group, 164 cases,68.0% ;for the 15 - 17 years group, 28 cases,70.0% ） were higher than those of the two age groups of less than 12 years （P 〈0.01 ）. ADHD patients without any comorbidities in the two age groups more than 12 years （for the 12 - 14 years group, 29 cases,12.0% ;for the 15 - 17 years group, 4 cases,10.0% ）were less than those in the two age groups of less than 12 years （for the 6 -8 years group, 126 cases,32.8% ;for the 9 - 11 years group, 110 cases,32.6% ; P 〈 0.01 ）. These characteristics maintained in boys. Conclusion： Many comorbid psychiatric disorders increase as the ADHD children become adolescents. The situation is severer in late adolescence. Therefore, ADHD children should accept appropriate treatment as early as possible, and adopt the second degree prevention actively.