整合视听持续测试诊断不同年龄段注意缺陷多动障碍患儿的临床应用

Clinical Application of Integrated Visual and Auditory Continuous Performance Test on Children with Attention Deficit Hyperactivity Disorder at Different Ages

目的探讨整合视听持续测试(IVA-CPT)对不同年龄段注意缺陷多动障碍(ADHD)诊断的临床应用价值。方法以美国精神障碍诊断和统计手册第4版(DSM-Ⅳ)为参照,对309例临床怀疑ADHD患儿进行IVA-CPT诊断,并按年龄将患儿分为6.0～6.9岁组、7.0～7.9岁组、8.0～8.9岁组、9.0～9.9岁组、10.0～10.9岁组、11.0～11.9岁组和12.0～15.0岁组,共7组,分别进行临床诊断评价,对比、评价IVA-CPT诊断不同年龄段ADHD临床价值。结果以DSM-Ⅳ为参照标准,IVA-CPT诊断ADHD各组的特异度不超过52.9%;7.0～7.9、8.0～8.9岁组敏感度最高(84.6%、85.4%),6.0～6.9、9.0～9.9岁组次之(76.9%、79.5%),10.0岁以上组敏感度最低(57.1%、61.5%、60.0%)。IVA-CPT与DSM-Ⅳ二种诊断方法对ADHD的阳性检出率比较,按年龄分组后二种诊断方法的ADHD的检出率之间无显著性差异(Pa>0.05);6.0～6.9岁组及10岁以上组在注意缺陷型,多动/冲动型,混合型二种诊断方法的符合率均<50%;7.0～7.9、8.0～8.9、9.0～9.9岁组符合率>60%,二种方法对分型诊断之间符合率的比较存在显著性差异(Pa<0.01)。二种方法在注意缺陷型诊断中符合率最高。结论IVA-CPT对7.0～8.9岁ADHD诊断价值较高,对较小及较大儿童还要结合临床行DSM-Ⅳ量表或其他量表评分,综合评定。IVA-CPT在分型诊断中建议只用于注意缺陷型的测定,对多动/冲动型的诊断需谨慎。

Objective To explore the clinical application of integrated visual and auditory continuous performance test （ IVA-CPT） on diagnosis in children with attention deficit hyperativity disorder （ADHD） at different ages. Methods The Putting Diagnostic and Statistical Manual of Mental Disorders（ DSM-IV ） as gold standard,309 cases of children with ADHD were tested by IVA -CPT. The data were ana- lyzed and the clinical examination was contrastly studied, which were divided into 7 groups as 6.0-6.9,7.0-7.9,8.0-8.9,9.0-9.9, 10-10.9,11.0-11.9,12.0-15.0 years old groups. The clinical diagnosis of different groups were evaluated. Results Putting DSM-IV as gold standard ,specificity for IVA-CPT was lower than 52.9% for all groups, but sensitivity for IVA-CPT was highest in 7.0-7.9, 8.0-8.9 years old groups（84.6% ,85.4% ）, next to in 6.0-6.9,9.0-9.9 years old groups （76.9%, 79.5% ）, and sensitivity for IVA-CPT were lowest over 10.0 years old groups （57.1% ,61.5% ,60.0% ）. Both of them had no significant differences （Pa〉 0.05 ）. Coincidence both of them in subtypes of ADHD diagnosed by 2 different ways were lower than 50% in the 6.0-6.9 and over 10.0 years old groups, but coincidence both of them were higher than 60% in 7.0-7.9,8.0-8.9,9.0-9.9 years old groups. What＇s more, there were significant differences though X^2 variance analysis in subtypes of ADHD by 2 different ways（Pa 〈0.01 ）. Coincidence both of them were high at diagnosis on children with predominantly inattentive type ADHD. Conclusions IVA-CPT is an good assisted tool for effective diagnosis of ADHD ,which is better in 7.0-8.9 years old groups. It should be generally diagnosed by DSM-IV or other scale except IVA-CPT for younger and older groups. At diagnosis in subtypes of ADHD, IVA-CPT is an assisted tool for effective diagnosis of ADHD in predominantly inattentive type. It should be very cautious at diagnosis of ADHD in other subtypes by IVA-CPT.