持续性操作测试对注意缺陷多动障碍诊断应用

Application of continuous performance task in diagnosis of attention deficit hyperactivity disorder

目的研究持续性操作测试在注意缺陷多动障碍诊断中的作用和意义。方法对2005年7月至2006年12月间在山西省妇幼保健院就诊的1 006例注意缺陷多动障碍患儿进行视觉和听觉持续性操作测试,比较两种测试对注意缺陷多动障碍及其亚型的阳性检出率、两种测试的临床判断一致性以及不同亚型的测试特征。结果患者中多动/冲动为主型184例(18.3%),注意缺陷为主型561例(55.8%),混合型261例(25.9%)。听觉持续性操作测试阳性检出率(91.1%)显著高于视觉持续性操作测试(73.0%),差异有显著的统计学意义(2χ=111.513,df=1,P<0.01);各亚型间听觉持续性操作测试和视觉持续性操作测试阳性检出率差异无显著性(2χ分别为3.018和5.030,df=2,均P>0.05);非参数检验R idit分析显示,视觉和听觉持续性操作测试对注意缺陷多动障碍各亚型严重程度的判断有显著性差异(2χ分别为19.840和6.417,df=2,分别P<0.01,P<0.05);持续性操作测试对多动/冲动为主型、注意缺陷为主型和混合型检出的Kappa值分别为0.134、0.131和0.063(Kappa值均<0.5);听觉持续性操作测试虚报错误和漏报错误T值各亚型间有显著性差异(F分别为16.709和6.105,均P<0.01)。结论持续操作测试对注意缺陷多动障碍的诊断具有一定的价值,其中听觉持续性操作测试敏感性更高;听觉和视觉持续性操作测试临床判断的一致性较差。

Objective To evaluate significance and role of continuous performance task （CPT） in diagnosis of attention deficit hyperactivity disorder（ADHD） in childhood. Methods 1 006 children with suspected ADHD who admitted to Shanxi provincial MCH Hospital from July 2005 to December 2006 and met the diagnostic criteria of DSM-Ⅳ were checked with visual and audio continuous performance tasks （CPT）. The positive detectable rate of ADHD and its subtypes by two CPT methods ,uniformities of the two methods with clinical judgmen, and the test features of different subtypes were compared. Results Among 1006 children with ADDH, ADHD-HI was seen in 184 children （ 18.3% ）, ADHD-I was seen in 561 children （55.8%）, and ADHD-C was seen in 261 children （25.9%）. The positive detectable rate by ACPT for ADHD （91.1%）was significantly higher than that by VCPT（73.0% ）, and the difference was significant （X^ = 111.513, df = 1, P 〈 0.01 ） ,but in distributions of different subtypes of ADHD identified by ACPT and VCPT, there were no significant differences （X^ = 3.018,5.030 ,respectively, df=2 ,all P 〉0.05）. Non-parametric test Ridit analysis showed that in judgment of severity of different subtypes of ADHD by VCPT and ACPT, there were significant differences（X^2= 19. 840,6. 417 ,df= 2 ,P 〈 0.01 ,P〈0.05 ,respectively）. Kappa values for the three types of ADHD by CPT were 0.134, 1. 131 and 0.063, respectively （all Kappa valuls 〈0.5）. In T values for omission errors （OE）, confusion errors （CE） and response time （RT） by ACPT between the three types of ADHD, there were significant differences （F = 16.709,6.105 ,respectively, all P 〈 0.01 ）. Conclusion CPT is of certain value for diagnosing ADHD in childhood, and the sensitivity of ACPT is higher than VCPT. However, the uniformities of ACPT and VCPT with clinical judgment are both poor.