儿童注意缺陷多动障碍共患病类型影响因素的临床研究

Clinical study of the influential factors related to the comorbidity types in children with attention deficit hyperactivity disorder

目的考察性别、家庭教养方式、学校教育方式、注意缺陷多动障碍（ADHD）临床亚型等因素对ADHD共患病类型的影响。方法应用VanderbihADHD家长和教师评定量表及自制的一般情况调查表确诊门诊ADHD患者224例，其中男205例，女19例，确定其临床分型及共患病，获取家庭和学校教养方式的相关信息。根据共患病类型分为ADHD组（n=118）、ADHD共患内化性行为障碍组（ADHD＋焦虑／抑郁）（n=10）、ADHD共患外化性行为障碍组（ADHD＋ODD／CD）（n=89）及ADHD共患内化和外化性行为障碍组（n=7），以无共患病为参照水平做无序多分类Logistic回归。结果混合型ADHD患儿（ADHD—CT）患外化性行为障碍概率比注意缺陷型（ADHD—PI）和多动冲动型ADHD患儿（ADHD—HI）高，分别是ADHD—PI和ADHD—HI患外化性行为障碍的概率的4．76倍（偏回归系数为1．58，P〈0．05）及6．25倍（偏回归系数为1．83，P〈0．05），即风险增加，均差异有统计学意义。接受负性家庭教养方式的患儿患外化性行为障碍的概率是接受正性家庭教养方式的患儿的2．01倍（偏回归系数为0．7，P〈0．05）。结论混合型ADHD儿童相对于注意缺陷为主型和多动冲动型ADHD儿童共患外化性行为障碍风险增高。接受负性的家庭教养方式的ADHD儿童患外化性行为障碍的风险增加。

Objective To investigation the effect of gender, family parenting style, school education style, the subtype of ADHD to the comorbidity types of attention defieithyperactivity disorder（ADHD）. Method Using the Vanderbih ADHD Rating Scales and self-designed questionnaire diagnosised 224 ADHD children （male 205 ,female 19 ） in out-patient clinic, definited their clinical subtype and eomorbidity. Through the rating scales to screen for the information about their family parenting styles and school education styles. According to their comorbidity type, they were divided into four groups ： pure ADHD group （ n = 118 ） , ADHD ＋ internalizing disorders （anxiety/depression） group（ n = 10）, ADHD ＋ externalizing disorders （ODD/CD） （ n = 89）, ADHD ＋ internalizing disorders ＋ externalizing disorders （ n = 7 ）. Results The probability of comorbidity externalizing disorders in ADHD-CT children was 4.76 times（ partial regression coefficient = 1.58, P 〈 0.05 ） as in ADHD-PI children, and 6.25 times （ partial regression coefficient = 1.83, P 〈 0.05 ） as in ADHD-PI children. The probabili- ty of eomorbidity externalizing disorders in ADHD children who received positive family parenting style was 2.01 times（partial regression coefficient =0.7, P〈0.05 ） as in children who received negative family parenting style. Conclusion ADHD-CT children have higher risk of co-existi externalizing disorders than ADHD-PI and ADHD- HI children. The ADHD children who received negative family parenting style have higher risk to have External- izing disorders.