长沙市中小学生对立违抗性障碍的现况及对照研究

A study of current state and clinical characteristics of oppositional defiant disorder in a primary school and a middle school in Changsha, China

目的 了解长沙市中小学生中罹患对立违抗性障碍 (ODD)的现况及临床特征。方法应用自制儿童行为学习调查表、Conners父母问卷 (PSQ)、教师问卷 (TRS)及Piers Harris儿童自我意识量表 (CSCS) ,于 2 0 0 0年 6～ 7月对长沙市某中学及某小学 (其中有效人数为 589人 )的 4 7例ODD儿童(研究组 )和 4 7名非ODD儿童 (对照组 )进行评定和病例 对照分析。结果 ( 1 )ODD发生率 :在 589人中符合ODD者为 4 7例 ( 8 0 % ) ,其中男性为 1 1 % ( 3 1例 ) ,女性为 5% ( 1 6例 ) ;发生率超过 50 %的症状有 :经常发脾气 ( 92 % ) ,常与大人争吵 ( 81 % ) ,常拒绝服从大人的要求或违反规则 ( 68% ) ,常因自己的错误或所做的坏事责备旁人 ( 68% ) ,常发怒或怨恨他人 ( 62 % )。 ( 2 )ODD合并其他疾病的发生率 :合并注意缺陷多动障碍为 51 % ( 2 4例 ) ,合并学习障碍为 3 8% ( 1 8例 ) ,与对照组 [分别为 1 7% ( 8例 )和1 5% ( 1 5例 ) ]比较差异有非常显著性 (均P <0 0 1 )。 ( 3 )各量表评分 :经t检验 ,PSQ中品行问题、学习问题、冲动 多动、焦虑及多动指数 ,以及CSCS中的行为、焦虑及总分两组比较 ,差异有非常显著性或显著性 (P <0 0 1或P <0 0 5)。结论 在长沙市某中学及某小学的学生中存在ODD 。

Objectives To study the characteristics of oppositional defiant disorder (ODD) in an urban primary school and a middle school in Changsha, China Methods The diagnosis of ODD was made according to the DSM Ⅳ criteria Children with ODD were compared with non ODD controls by the self compiled scale for evaluating children′s behavior and learning, Conners′ patient symptom questionnaire (PSQ), teacher report scale (TRS) and Piers Harris children′s self concept scale (CSCS) Results (1) Among the 589 children, 47 met the criteria for ODD The incidence of ODD was 8% with 11% in boys and 5% in girls The most seen symptoms in order were 'often loses temper (92%), often argues with adults (81%), often actively defies or refuse to comply with adults′ requests or rules (68%), often blames others for his or her mistakes or misbehavior (68%), and often be angry and resentful (62%)' (2) In ODD group, 51% and 38% of the children suffered ADHD or learning disorder (LD) simultaneously, which were significantly higher than that (17% or 15%) in control group respectively ( P <0 01) The ODD group differed from control group in the sub scale of behavior( t =2 89, P <0 01) and anxiety( t =2 06, P <0 05), and total scale( t =2 12, P <0 05) scores of CSCS They differed on the conduct problems, learning problem, impulsive hyperactive, anxiety, and hyperkinetic index of PSQ scores ( t =7 15, 3 69,5 87, 2 83 and 6 56,respectively, P <0 01) No significant results were yielded in comparison of TRS scores Conclusions It is suggested that prevalence of ODD in this sample be resembled the report from abroad that 9% of children suffer from ODD Children with ODD have more learning and/or behavioral dysfunction