父母培训结合利他林治疗共患对立违抗障碍的注意缺陷多动障碍患儿的研究

Effects of parents training combined with ritalin and only ritalin on treating attention deficit hyperactivity disorder comorbid with oppositional defiant disorder among children

目的评估父母培训八步法结合利他林的联合治疗方案对共患对立违抗障碍(ODD)的注意缺陷多动障碍(ADHD)患儿的疗效。方法采用严格的随机对照法将符合美国《精神障碍诊断与统计手册(第4版)》中ADHD+ODD诊断标准的患儿分为单用利他林治疗组(单药组,32例)和联合治疗组(联合组,30例)。于治疗前和治疗10周后进行DBDRS、Conners父母问卷、PSI及CGI等评估。结果治疗前两组ADHD症状评分、ODD症状评分、Conners父母问卷评分及CGI评分差异均无统计学意义(均>0.05);治疗后联合组ODD症状评分、Conners父母问卷品行障碍因子分均低于单药组(均<0.01),ADHD症状评分两组差异无统计学意义(>0.05);ODD症状的减分率与注意缺陷症状的减分率有正性相关(=0.39,<0.01);培训后家长对联合治疗的满意度达83.33%。讨论父母培训结合利他林是治疗共患ODD的ADHD合适的方案,值得在临床推广。

Objective To evaluate the effectiveness of Russell Barkley＇s parents training combined with ritalin on attention deficit hyperactivity disorder（ADHD） comorbid with oppositional defiant disorder（ODD） among children.Methods 75 ADHD＋ODD children were randomized to parents training combined with methyphenidate group（combination therapy group,30cases） and only ritalin treatment group（32cases）.Before and after 10-week treatment,DBDRS, Conners＇ parents rating scale,PSI and CGI were used to evaluate the symptoms and effectiveness.Results Before the treatment,there were no significant differences in the total score s of ADHD symptoms and ODD symptoms,the total scores of Conners＇ parents rating scale and CGI（P〉0.05）.After the treatment,there were no significant differences in the total scores of ADHD symptom（P〉0.05）,but in the combination therapy group,the total scores of ODD symptoms and the conduct factor scores of Conners＇ parent rating scale were lower（P〈0.01）,the reduction rate of the ODD symptoms was positively correlated with the reduction rate of attention defici（r =0.39）.As CGI and CSI showed,with the reduction of the diseases severity and parents pressure,the overall treatment progress and the combination therapy group are all better than Ritalin group（0.01）.Therewere no significant differences in the effectiveness ofADHD symptoms in the two groups,but the effectiveness rate of ODD symptoms of the combination group was higher（65.70%vs 26.30%）,and parents satisfaction was 83.33% after the training.Conclusions Parents training combined with ritalin is useful to comorbidity of attention deficit hyperactivity disorder and oppositional defiant disorder and it is deserved to be generalized in clinical practice.