边缘智力与注意缺陷多动障碍儿童行为问题及执行功能特征研究

Behavioral problems and executive functioning characteristics in children with borderline intellectual functioning and attention deficit hyperactivity disorder

目的 通过比较分析边缘智力（borderline intellectual functioning,BIF）、注意缺陷多动障碍（attention deficit hyperactivity disorder,ADHD）儿童和健康对照组（typically developing control,TDC）在行为问题、智力水平和执行功能的差异,探讨BIF和ADHD的心理行为特征、执行功能与智力的关系及影响因素.方法 采用Conners父母症状问卷（PSQ）、Achenbach儿童行为量表（CBCL）、中国韦氏儿童智力量表（C-WISC）评估和整合视听连续执行测试（IVA-CPT）,比较了60例BIF儿童、60例ADHD儿童和60例健康儿童的行为问题、智力水平和执行功能的差异,分析不同心理特征之间的相关性.结果 （1）行为问题：BIF社会退缩因子[（3.68±2.85）分]得分低于ADHD[（2.82±2.24）分]、TDC[（1.03±1.59）分];ADHD品行问题、冲动-多动、多动指数、违纪、攻击因子得分高于BIF、TDC;ADHD、BIF学习问题、焦虑、抑郁、躯体诉述、多动因子得分高于TDC;ADHD心身障碍因子得分[（0.21±0.25）分]高于BIF[（0.13±0.17）分]、TDC[（0.08±0.13）分],均差异有统计学意义（P＜0.01）;（2）执行功能：BIF视觉反应正确率（0.71±0.25）低于ADHD（0.83±0.17）、TDC（0.94±0.05）;BIF视觉漏报数（12.17±10.48）高于ADHD（6.95±7.20）、TDC（2.33±2.48）;BIF（0.85±0.13）、ADHD（0.88±0.09）听觉反应正确率低于TDC（0.96±0.03）;BIF、ADHD视觉平均反应时、听视觉反应变异率、听视觉虚报和听觉漏报数高于TDC,以上差异均有统计学意义（P＜0.01）;BIF、ADHD和TDC听觉平均反应时差异无统计学意义（P＞0.05）;（3）心理特征的相关分析：智力水平（言语智商、操作智商、总智商）与PSQ和CBCL量表中多项因子具有相关性,其中与品行问题、学习问题、冲动多动、焦虑、多动指数、抑郁、社交退缩、多动、违纪、攻击行为的相关性尤为密切（P＜0.01）;此外,智力水平还与听视觉反应正确率、视觉平均反应时、听视觉反应变异率、听觉反应虚报数、听视觉反应漏报数有明显的相关性（P＜0.01）;执行控制能力中各项指标（听视觉反应正确率、听视觉平均反应时、听视觉反应变异率、听视觉反应虚报数、听视觉反应漏报数）与PSQ和CBCL量表的多项因子具有相关性,其中与学习问题、多动冲动、多动指数、多动行为的相关性尤为密切（P＜0.05）.结论 BIF和ADHD儿童均存在执行功能障碍,并且在行为问题和神经心理学特征上表现不同的损伤剖面,心理行为特征之间的高关联度提示执行功能障碍可能是导致BIF和ADHD智力损害和心理、行为问题产生的主要因素.

Objective To investigate the behavioral problems,intellectual ability and executive functioning characteristics as well as their correlations in children with borderline intellectual functioning （BIF） and attention deficit hyperactivity disorder （ADHD）.Methods 60 children with BIF,60 children with ADHD and 60 typical developing children （TDC） participated this study.Parental report measures of behavioral problems were administrated using the Conners＇ Parent Symptom Questionnaire （PSQ） and Achenbach Children Behavior Checklist Scale （CBCL）.All the participants performed the Chinese Revised Wechsler Intelligence Scale for Children （C-WISC） and a neuropsychological test named integrated visual and auditory continuous performance test （IVA-CPT）.Comparison of cognitive profiles and correlation between psychological features were carried out to test the differences and commons among the groups.Results （1） Behavioral problems：the children with BIF had higher scores（3.68±2.85） in withdrawal factor than the children with ADHD （2.82±2.24） and TDC （1.03± 1.59）.The children with ADHD had higher scores in conduct,impulsivity,aggressive and delinquent behavior than the children with BIF and TDC.The children with BIF/ADHD had higher scores in learning,anxiety,depression,somatic complaint and hyperactivity than the TDC.（2） Executive functioning：the children with BIF had more visual omission error （12.17± 10.48） than the children with ADHD （6.95±7.20） and TDC （2.33±2.48）.The children with BIF and ADHD had lower auditory accuracy and higher visual reaction time,visual/auditory response variability,visual/auditory misrepresentation and auditory omission numbers than the TDC.These was no group difference in auditory reaction time.（3） Correlation analysis：intellectual ability was correlated with behavior problems and neurophysiological index such as conduct,learning,impulsivity,anxiety,depression factors,visual/auditory accuracy,visual reaction time and visual/auditory response variability.Conclusion BIF and ADHD are associated with poor executive functioning and increased behavior problems.The cognitive deficit may be a marker of vulnerability of poor academic and social outcomes in children with BIF and/or ADHD.