儿童注意缺陷多动障碍的几种诊断方法探讨

A study on diagnosing of attention deficit hyperactivity disorder in children by using different methods.

目的 探讨儿童注意缺陷多动障碍 (ADHD)的诊断方法。方法 对家长或教师认为“多动”的 6～ 1 1岁儿童 1 98例 ,采用美国《精神障碍诊断和统计手册》第 4版 (DSM Ⅳ )的标准、持续性注意测验 (CAT)、Conners父母症状问卷 (PSQ)和简明症状问卷 (ASQ)分别作诊断。结果 4种方法诊断为ADHD的分别有 1 1 0例、1 0 5例、1 0 5例和 95例 ,相应占 55 6 %、53 0 %、53 0 %和 4 8 0 %。后三者分别与前者比较均无显著差异 ( χ2 值分别为 0 2 5、0 .2 5和 2 2 8,P均大于 0 0 5)。CAT、PSQ和ASQ与DSM Ⅳ诊断比较 ,分别有 96 2 %、95 3%和 95 8%为符合与基本符合。CAT的敏感性、特异性和准确性分别为 91 8%、95 5%和 93 4 % ,PSQ的三项相应为 90 9%、94 3%和 92 4 % ,ASQ的三项相应为 77 3%、88 6 %和 82 3%。结论 CAT和PSQ的敏感性、特异性和准确性分别相近或高于目前最常用的ASQ(CAT三项的 χ2 分别为 8 91、2 79和 1 1 4 7,PSQ三项的 χ2 分别为 7 6 4、1 82和 9 1 6 ,P均分别为小于 0 0 5、大于 0 0 5和小于 0 0 5)。对DSM Ⅳ诊断标准具有较客观的补充作用 。

Objective To explore diagnostic methods of attention deficit hyperactivity disorder (ADHD) in children.Methods 198 cases of 'hyperactivity child' considered by their parents or teachers, aged from 6 to 11 years, were examined with DSM Ⅳ, continuous attention task (CAT), parent symptom questionnaire (PSQ) and abstract symptom questionnaire(ASQ).Results 110 cases (55 6%),105 cases (53 0%), 105 cases (53 0%) and 95 cases (48.0%) were diagnosed as ADHD by the four methods respectively. There were no significant difference in the diagnosis among four methods ( χ 2=0 25, 0 25, 2.28; P>0 05 ). 96 2%, 95.3% and 95.8% scoring of CAT, PSQ and ASQ corresponded with the diagnosis by DSM Ⅳ respectively. The sensitivity, specificity and accuracy of CAT are 91 8%, 95 5% and 93 4%; that of PSQ are 90 0%, 94 3% and 92 4%; that of ASQ are 77.3%, 88.6% and 82.3%.Conclusions The sensitivity, specificity and accuracy of CAT and PSQ are better than or the same as that of ASQ (compared with CAT, χ 2 =8 97, 2 79 and 11 47; P <0 05, >0 05 and <0 05; compared with PSQ, χ 2 =7 64, 1 82 and 9 16, P <0 05, >0 05 and <0 05) which are used frequently at the present. CAT and PSQ can be used in complement to DSM Ⅳ and is worthy of recommendation.