小脑运动训练对注意缺陷多动障碍患儿疗效的研究

Therapeutic effects of exercise-based treatment programme on children with attention-deficit/hyperactivity disorder

目的 探讨小脑运动训练（DDAT）对不同亚型注意缺陷多动障碍（ADHD）伴直立平衡功能异常患儿的治疗作用.方法 对符合美国《精神障碍诊断与统计手册（第4版）》ADHD诊断标准,伴直立平衡功能失调的91例ADHD患儿,其中,注意缺陷型ADHD（ADHD-I） 43例、多动-冲动型ADHD（ADHD-HI） 15例、混合型ADHD（ADHD-C） 33例均予DDAT治疗6个月,分别于DDAT治疗前、开始治疗后3个月和6个月、治疗结束后3个月对各亚型进行SNAP-Ⅳ量表评估,治疗前后进行直立平衡功能、Conners父母症状问卷分析.结果 ADHD-I、ADHD-HI、ADHD-C的注意缺陷评分治疗前（1.99±0.34、0.96 ±0.31、2.17 ±0.31）均高于治疗结束后3个月（1.19 ±0.45、0.81 ±0.28、1.32 ±0.37）,ADHD-I和ADHD-C差异有统计学意义（P＜0.05）.ADHD-I、ADHD-HI、ADHD-C治疗前和治疗结束后3个月的多动/冲动评分分别为0.81 ±0.35、2.01±0.35、1.96±0.33vs.0.45±0.33、0.79 ±0.41、1.10 ±0.35,各亚型差异均有统计学意义（P＜0.05）.Conners父母症状问卷调查中,品行问题（1.11 ±0.48vs.0.76 ±0.44）、学习问题（1.97 ±0.58vs.1.60±0.67）、身心问题（0.61±0.49 vs.0.29±0.35）、多动-冲动（1.46±0.69vs.1.09 ±0.55）、焦虑（1.05±0.63vs.0.62±0.47）评分较治疗前均有显著降低,差异均有统计学意义（P＜0.05）.平衡功能测试仪检测,治疗后平衡功能失调改善的有效率87.9％,亚型之间有效率差异无统计学意义（P＞0.05）.结论 DDAT对有直立平衡功能异常的ADHD患儿安全有效,针对改善小脑功能的运动训练能明显改善ADHD患儿的症状和平衡功能.

Objective To evaluate the effects of an exercise-based treatment programme （dyslexia,dyspraxia and attention-deficit treatment,DDAT） on various subtypes of attention-deficit/hyperactivity disorder （ADHD）.Method Ninety-one ADHD children with standing balance dysfunction （ADHD-I 43,ADHD-HI 15 and ADHD-C 33） were given DDAT for 6 months,the efficacy of DDAT was evaluated before DDAT,three,six months after the treatment and three month after end of the treatment according to SNAP-Ⅳ,before and after the treatment by balancing function test and Conners Parents Rating Scale.Result Inattention subscale scores of ADHD-I,ADHD-HI and ADHD-C before and after the interventions were 1.99 ±0.34,0.96 ±0.31,2.17 ±0.31and 1.19 ±0.45,0.81 ±0.28,1.32 ±0.37,differences of ADHD-I and ADHD-C were significant （P ＜ 0.05）,hyperactivity subscale scores of three subtypes of ADHD were 0.81 ±0.35,2.01 ±0.35,1.96 ±0.33 vs.0.45 ±0.33,0.79 ±0.41,1.10 ±0.35,there were significant differences as well （P ＜ 0.05）.The score of hyperactivity symptom was reduced more compared to that of inattention symptom by the SNAP-Ⅳ scale parent forms.There were significant difference before and after the treatment based on Conners parent scale for conduct problem（1.11 ± 0.48 vs.0.76 ±0.44）,learning problem （1.97 ±0.58 vs.1.60 ±0.67）,psychosomatic problems（0.61 ±0.49 vs.0.29 ± 0.35）,activity/ hyperactivity （1.46 ± 0.69 vs.1.09 ± 0.55） and anxiousness （1.05 ± 0.63 vs.0.62 ± 0.47） as well （P ＜ 0.05） ; the standing balance dysfunction improved for most of the children,total effective rate was 87.9％,no significant difference was found among the three subtypes （P ＞ 0.05）.Conclusion DDAT is a safe and efficient intervention for the ADHD children with standing balance dysfunction,the improvement on hyperactivity symptom was better than that on inattention symptom.This study shows that an exercise-based treatment programme for cerebellum function improves symptoms of ADHD and balance function.