共患破坏性行为障碍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 disruptive behavior disorders

目的:探讨共患破坏性行为障碍(DBD)的注意缺陷多动障碍(ADHD)男孩的执行功能特点。方法:以年龄匹配的、符合美国《精神障碍诊断与统计手册(第4版)》(DSMⅣ-)诊断标准的ADHD合并对立违抗性障碍(ODD)或品行障碍(CD),单纯ADHD和正常对照各19例男孩为研究对象,采用Stroop色词命名任务、Rey复杂图形测试(RCFT)、数字广度、连线测试、汉诺塔任务和言语流畅性任务对其执行功能的各个层面进行评估。结果:(1)两病例组的Stroop 2,4试耗时,4试错误数,Rey复杂图形测试的延迟回忆结构得分、即时和延迟记忆的细节得分,汉诺塔任务中犯规步数的测验成绩均明显差于正常对照组,差异有统计学意义(P<0.05),但两病例组之间差异无统计学意义(P>0.05)。(2)单纯ADHD组的Stroop 2试错误数、3试耗时及错误数、字义干扰时,Rey复杂图形测试的即时记忆结构得分,数字字母连线时间和错误数、转换时间,汉诺塔操作总时间和总步数的测验成绩均明显差于正常对照组,差异有统计学意义(P<0.05)。(3)ADHD共患DBD组的Stroop 2试耗时(P=0.044)和4试错误数(P=0.022)的测验成绩优于单纯ADHD组。结论:ADHD共患DBD组儿童与正常儿童相比,在反应抑制、工作记忆和定势切换的执行功能层面上存在明显受损;但与单纯ADHD组儿童相比,其执行功能的受损范围小。

Objective： To answer the question whether executive function （EF） deficits are specific to attention deficit hyperactivity disorder （ADHD） or whether such deficits are also associated with disruptive behavior disorders （DBD）, including oppositional defiant disorder （ODD） and conductive disorder （CD）. Methods： A total of 19 pure ADHD boys, 19 ADHD ＋ DBD boys and 19 normal controls （criteria of DSM-Ⅳ ） were collected as our samples. The groups were matched by age （less than 6 months）. The research instruments included 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 IQs weren＇ t significant among three groups. （ 1 ） Both pure ADHD group and ADHD ＋ DBD group performed worse （ P 〈 0.05 ） in the aspects of the time of Stroops 2 and 4, errors of Stroop 4; the delay recalling structure and detail score, the immediate memory detail score of Rey complex figure test ; error steps （ rule violation） of tow of Hanoi. But the differences between pure ADHD and ADHD ＋ DBD weren＇ t significant （P 〉 0.05 ）. （2） Pure ADHD group also showed deficits in the aspects of errors of Stroop 2, time and errors of Stroop 3, word interference time ; immediate memory structure score of Rey complex figure test ; time and errors of number-letter part and shifting time of trail making test ; total time and steps of completing tower of Hanoi. The differences were significant （ P 〈 0.05 ）. （3） ADHD ＋ DBD group performed better on the time of naming color of the color block card （ part 2, P = 0. 044 ） and color-word card （ part 4, P = 0. 022 ）, and also had the tendency to shorter word interference time （P = 0. 055 ） than pure ADHD group. Conclusion ： The findings support the hypothesis that ADHD is related to EF deficit, whether or not comorbid DBD. ADHD ＋ DBD group showed significant difference in the aspects of inhibition and working memory as compared with the normal group, but the area and degree of EF deficits were less than pure ADHD group.