父母培训结合利他林治疗对立违抗障碍ADHD患儿疗效观察

A follow-up study of parent training treatment in children with attention deficit hyperactivity disorder comorbidity oppositional defiant disorder

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ADHD的疗效,探索合适的治疗方案。方法对符合DSM-IV中ADHD+ODD诊断标准的患儿,用父母培训法联合利他林治疗与单用利他林的药物治疗进行随机对照,治疗10周后撤除父母培训法,在第34周进行随访。共完成观察病例62例,32例利他林治疗,30例联合治疗。以破坏性行为障碍评定量表(DBDRS)、家长压力问卷(PSI)、临床总体印象(CGI)等评估症状及疗效。结果治疗前两组ADHD症状评分、ODD症状评分及CGI评分差异均无统计学意义(P值均>0.05);治疗10周末及随访34周末均一致显示,两组ADHD症状改善及疗效差异无统计学意义(P>0.05),联合治疗组对ODD症状的改善和疗效、减轻疾病严重程度和家长压力等方面优于单用利他林组(P<0.01);ODD症状的改善与注意缺陷症状的改善有正性相关(r=0.39,P<0.01)。结论父母培训结合利他林治疗共患ODD的ADHD疗效肯定,值得在临床推广。

Objective To assess the effectiveness of Russell Barkley＇s parent training combined with Ritalin in children with attention deficit hyperactivity disorder（ADHD） comorbidity oppositional defiant disorder（ ODD）. Methods Sixty-two children met DSM-1VADHD＋ODD were randomized to parent training combined with Ritalin treatment group （ 30 cases）and only Ritalin treatment group （32 cases） for 10 weeks and were followed up at the 34th week. Before and after the treatment, Disruptive Behavior Disorder Rate Scale （ DBDRS）, Parenting Stress Index （ PSI ） and Clinical Global Impressions （ CGI I were used to evaluate the symptom and effectiveness. Results Before treatment, there were no significant differences in the total score of the ADHD symptom and the ODD symptom （ P〉0.05 ）. Both 10 weeks＂ treatment later and followed-up 34 weeks showed that there were no significant differences on progresses and effectiveness of the ADHD symptom（P〉0.05 ）, but it was better in parent training com- bined with Ritalin on progresses and effectiveness of the ODD symptom than only Ritalin treatment group （ P〈0. 01 ）, and it＇s superior in the parent training combined with Ritalin group to only Ritalin treatment group in the reduction of disease degree and parents＂ stress . Symptoms of the ODD had positive correlation with the reduction rate of the reduction rate of attention deficit （ r = 0.39, P〈O. 01 ）. Conclusion Parents＂ training combined with Ritalin is useful to comorbidity of attention deficit hyperactivity disorder and oppositional defiant disorder and deserve to be generalized in clinical practice.