不同亚型注意缺陷多动障碍男童行为特点分析

An analysis of behavioral characteristics of boys with different subtypes of ADHD

目的了解6～11岁不同亚型单纯注意缺陷多动障碍男童的年龄、行为及注意力的差异。方法对2006年1—10月期间首次就诊于首都儿科研究所附属儿童医院心理门诊，临床诊断为单纯注意缺陷多动障碍的6—11岁男童185例，依据美国《精神障碍诊断与统计手册》第4版标准诊断、分型，同时请家长采用Achenback儿童行为量表对儿童行为进行评定，注意力检查应用数字划消测验。结果①注意缺陷多动障碍中的注意缺陷为主型、多动冲动为主型、混合型所占比例分别为41．6％（77例）、7．0％（13例）和51．4％（95例），平均年龄分别为8．3±1．3岁、8．0±1．7岁和7．7±1．4岁。3种类型儿童年龄分布比较有统计学差异（Χ^2=7．185，P=0．028），其中注意缺陷为主型与混合型的年龄分布比较亦有统计学差异（Χ^2=7．354，P=0．007）；②行为量表总分、外向分、外向因子多动、攻击、违纪得分在不同亚型儿童之间存在差异（F值分别为10．17、24．51、11．89、24．35、16．26，均P〈0．01），其中注意缺陷为主型与混合型的总分、外向分、外向因子多动、攻击、违纪比较均有统计学差异（t分别为-4．50、-6．95、-4．86、-6．96、-5．67，均P〈0．01）；③不同亚型的数字划消测试失误率轻、中、重百分比无统计学差异。结论6-11岁注意缺陷多动障碍男童中，注意缺陷的程度无明显差异，注意缺陷多动障碍混合型儿童比注意缺陷为主型儿童就诊较早，且比注意缺陷为主型儿童有更多的行为问题，尤其是外向性行为问题，故注意缺陷多动障碍混合型儿童更需综合干预。

Objective To investigate differences in age, behavior and attention of boys with different subtypes of simple attention deficit hyperactivity disorder （ADHD） aged 6 - 11years. Methods 185 boys with a clinical diagnosis of simple ADHD ages 6 - 11 years who firstly referred to The Psychological Clinic of The Affiliated Children＇ s Hospital of Capital Institute of Pediatrics over a period from January to October, 2006 were diagnozed and classified according to DSM-IV. At the same time, the boys＇ behaviors were assessed by using CBCL filled by their parents. The number cancellation test was used to examine the boy＇ s attention disorder. Results （1） The proportions of predominately inattentive type of ADHD （ADHD-I, n = 77 ）, predominately hyperactive-impulsive type of ADHD （ADHD-HI, n = 13 ） and combined type of ADHD （ADHD-C, n =95） were 41.6%, 7.0% and 51.4% respectively in order. The mean ages of boys with ADHD-I, ADHD-HI and ADHD-C were 8.3± 1.3 years old, 8.0 ± 1.7 years old and 7.7 ± 1.4 years old respectively, and there was a significant difference between the three age groups in age distribution of boys with three types of ADHD （Χ^2 = 7. 185, P = 0. 028 ）, of which, between ADHD-I group and ADHD-C group there was a significant difference in age distribution of boys with ADHD-I and ADHD- C （Χ1：C^2 = 7. 354, P = 0. 007 ） ; （2） In total scores in CBCL, scores in extroversion behavior problems, and scores in three extraversive factors： hyperactivity behavior, aggressive behavior and delinquent behavior, there were statistically significant differences between the three groups （F = 10.17, 24.51, 11.89, 24.35, 16.26 respectively, all P 〈 0.01 ）. Of which, between ADHD-I and ADHD-C, there were significant differences in six sores of boys with ADHD （t = - 4.50, - 6.95, - 4.86, - 6.96, - 5.67 respectively, all P 〈 0.01 ） ; （2） In proportion of mild, moderate and severe missing rates in attention disorder test （ADT）, there was no statistically significant difference between the three groups. Conclusion Among boys with ADHD aged 6 - 11 years, there is no significant difference in severity of attention deficit. Those boys with ADHD-C have more behavior problems, especially extraversive behaviors and see a docter earlier than those boys with ADHD-I. So, for this type of ADHD boys, more comprehensive interventions are needed.