学校与家庭行为干预辅佐速释哌甲酯综合治疗儿童注意缺陷多动障碍依从性相关因素分析

Relative factors analysis of the compliance of methylphenidate for children with attential deficit hyperactivity disorder aided by the behavior intervention techniques of the school and family

目的探讨学校及家庭行为矫正治疗辅助哌甲酯治疗儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)依从性的相关因素。方法随访190例ADHD患儿,应用学校及家庭行为矫正治疗辅助哌甲酯综合治疗,并使用自行设计的一般情况调查表、抑郁自评量表(Self-Rating Depression Scale,SDS)、焦虑自评量表(Self-Rating Anxiety Scale,SAS)和家庭环境量表中文版(Family Environment Scale,FES-CV)测试患儿本身、家庭情况及看护人情况,并统计ADHD患儿综合治疗依从性的相关因素。结果随访到24个月,能坚持到6个月的有68名,占35.79%,能坚持到12个月的有45名,占23.68%,能坚持到18个月的有25名,占13.16%,能坚持到24个月的有21名,占11.05%。多元逐步回归分析结果显示,提高ADHD患儿综合治疗的依从性因素有:多动指数减分率、看护人参加多动症治疗宣教时间、看护人受教育年限、家庭环境亲密度及家庭环境组织性(标准回归系数分别为:0.36、0.34、0.39、0.26和0.31)。而降低患儿治疗的依从性因素有:治疗副反应、看护人抑郁评分、看护人焦虑评分及家庭环境矛盾性(标准回归系数分别为:-0.24、-0.19、-0.42和-0.32)。结论治疗的效果好,看护人受教育程度高,家庭环境亲密度及组织性好,看护人接受专科医生的宣教多,ADHD综合治疗的依从性就好。相反,治疗副反应多,看护人抑郁、焦虑情绪及家庭环境矛盾性高则影响治疗依从性。

Objective To analyse the relative factors of the compliance of methylphenidate for children with attential deficit hyperactivity disorder（ADHD）aided by the behavior intervention techniques of the school and family. Methods A total of 190 cases of ADHD were followed up,treated by the comprehensive treatment of the behavior modification techniques of the school family aiding methylphenidate,and investigated with self edited general questionnaire,Self-Rating Depression Scale（SDS）,Self-Rating Anxiety Scale（SAS）,and Family Environment Scale-Chinese Version（FES-CV）to test the status of children,their families and their parents,and the relative factors of ADHD children＇s comprehensive treatment compliance were analyzed. Results The follow-up period was 24 months,with 68（35.79%）children persisting to 6months,45（23.68%）persisting to 12 months,25（13.16%）persisting to 18 months and 21（11.05%）to 24 months.Multiple stepwise regression analysis suggested that the factors improving the compliance of ADHD children＇s comprehensive treatment included index of hyperactivity deduction rate,the time their parents spend attending publicity and education of the ADHD treatment,the period their parents received education,intimacy and organization of family environment（standardized regression coefficients were 0.36,0.34,0.39,0.26 and 0.31respectively）.The reducing factors were the side effect of children,the depression score and the anxiety score of their elder members of the family or the contradiction of the family environment（standardized regression coefficients were-0.24,-0.19,-0.42and-0.32respectively）. Conclusion The good compliance of ADHD comprehensive treatment results from long duration of diseases,high cultural level of their elder members of the family,excellent intimacy family environment and organization,much publicity and education from specialist,whereas intergenerational attending,the depression and anxiety feelings of their elder members of the family and high conflict of family environment decrease the compliance.