鲁北地区4～16岁学生注意缺陷多动障碍患病情况及其家庭环境调查

An investigation of ADHD and family environment in 8235 school children aged 4～16 years in Northern Shandong

目的了解鲁北地区低龄人群注意缺陷多动障碍(ADHD)的流行情况,并分析其家庭环境特征。方法应用问卷调查和专科访谈相结合的方法,采用自制的注意力及多动问题量表和家庭环境量表-中文版(FES-CV)调查分层随机整群抽样的4～16岁学生8235名,ADHD的诊断依照美国精神障碍诊断和统计手册第四版(DSM-Ⅳ)。家庭环境调查时选择550名与ADHD学生性别、年龄、班级、家庭经济状况相匹配的健康学生为对照组。结果①患病率:ADHD总患病率为6.3%(515/8235),其中男性患病率高于女性(8.1%vs4.4%,P<0.001);6～11岁组患病率高于4～5岁组(7.7%vs6.1%,P=0.02)和12～16岁(7.7%vs5.3%,P=0.002);②亚型分布:ADHD-I是4～16岁人群ADHD的主要类型,占56.3%;不同年龄组ADHD亚型分布差异有统计学意义(P<0.001),高年龄组ADHD-I比例增加;4～5岁组不同性别的亚型分布差异有统计学意义(P<0.001),男性以ADHD-HI为主,女性以ADHD-I为主,6～11岁组、12～16岁组亚型分布的性别差异均无统计学意义(P>0.05);③家庭环境:ADHD组FES-CV量表的亲密度、情感表达、知识性、道德宗教观、组织性分值低于正常组(P<0.001),娱乐性和矛盾性分值高于正常组(P<0.001)。结论6～11岁人群和男性的ADHD患病率较高,年龄和性别对亚型分布有影响,注意力缺陷是ADHD核心症状;ADHD患者的家庭环境差。

Objective To investigate the incidence of attention deficit and hyperactivity disorder （ADHD） and their family environment features among school children aged 4 - 16 years in Northern Shandong. Methods The present research attempts to make a qualitative as well as a quantitative analysis by using questionnaire and interview. Based on the methodology, a total of sample of 8235 children aged 4 - 16 years in Northern Shandong area were randomly stratified sampled out as experimental group from three levels of 20 kindergartens and schools in 4 counties and cities of Northern Shandang. The diagnosis of ADHD was based on the fourth edition of the U.S. Diagnostic and Statistical Manual of Mental Disorders （DSM-Ⅳ） was investigated by asking the parents to complete DSM-Ⅳ questionnaires and Family environment scal- chinese version（FES-CV）. Five hundred fifty gender-, age-, class- and family economic conditions-matched healthy children was served as the control group. Results （1）Incidence： The incidence of ADHD in school children aged 4 - 16 years was 6. 3%, 8. 1% and 4. 4% in total, male and female, respectively. The incidence of ADHD was much higher in male than in female（P 〈0. 001 ）. The incidence of ADHD in children aged 6 - 11 years was 7. 7% , which was higher than that of 4 -5 years （6. 1% ） （P =0.019）or 12 - 16 years（5.3% ） （P =0. 002）. （2） The subtype distribution： ADHD-I as main types of ADHD in children aged 4 - 16 years was 56. 3%. Distribution of subtypes was different in different age groups, ADHD-HI ratio significantly decreased whereas ADHD-I ratio significantly increased in higher age groups （ P 〈 0. 001 ）. For 4 -5 year-old children, distribution of subtypes was different between gender, ADHD-HI and ADHD-I were main types to boys and girls respectively（P 〈0. 001 ）. For 6 - 11 and 12 statistically significant （ P 〉 0. 05 ）. （3） Family environment ： 16 year-old groups, the difference between gender was not ADHD children had lower scores of FES-CV in family cohesion, emotional expression, intellectual-cultural orientation, moral concept of religion and organization and higher scores in entertainment and contradiction compared with normal children （ P 〈 0. 001 ）. Conclusions Incidence of ADHD is the highest in children aged 6 - 11 years, and incidence of ADHD is higher in male than in female. Inattention is the core deficit of ADHD. The age and gender have effects on ADHD subtypes. ADHD children live in a comparatively worse family environment which implicates an important role of the family environment in ADHD.