首诊注意缺陷多动障碍儿童的语义理解与工作记忆

Relationship between semantic comprehension and working memory in first-episode children with attention-deficit/hyperactivity disorder

目的:探讨注意缺陷多动障碍(ADHD)儿童语义理解与工作记忆特点及其二者间的关系。方法:按照美国精神障碍诊断与统计手册第4版(DSM-IV)关于ADHD的诊断标准,纳入30例首诊未用药的ADHD儿童(年龄6~13岁),同时纳入性别、年龄相匹配的30例正常儿童作为对照组。采用中文版注意缺陷多动障碍评定量表-父母版(SNAP-IV)进行症状评估,采用中国修订韦氏儿童智力量表(CWISC)的词汇分测验和皮博迪图片词汇测验(PPVT)中文修订版进行语义理解测验,用数字广度测试言语工作记忆,心理旋转和点矩阵任务测试视觉空间工作记忆。结果:ADHD组词汇测验得分[(12.2±2.7)vs(14.4±2.9),P<0.05]、PPVT得分[(112.3±9.7)vs(117.5±8),P<0.05]均低于对照组;ADHD组数字广度-倒背[(3.9±1.4)vs(5.1±1.7),P<0.05]、心理旋转[(4.9±1.8)vs(6.0±1.7),P<0.05]及点矩阵任务得分[(2.7±1.4)vs(3.5±1.5),P<0.05]均低于对照组,数字广度-顺背两组差异无统计学意义(P>0.05);ADHD组词汇得分与心理旋转任务得分呈正相关(r=0.40,P<0.05),PPVT测试与工作记忆各测试结果的相关均无统计学意义(P>0.05),对照组词汇测验、PPVT测试与各项工作记忆测试结果的相关无统计学意义(P>0.05);ADHD组的注意缺陷、多动/冲动因子及其总分与点矩阵任务呈中度负相关(r=-0.56^-0.60,均P<0.05)。结论:首诊ADHD儿童存在语义理解缺陷和工作记忆损伤,视空间工作记忆可能对ADHD儿童的语义理解有干扰作用。

Objective： To examine the relationship between semantic comprehension and working memory in first-episode children with attention-deficit/hyperactivity disorder（ADHD）. Methods： Thirty children aged 6 - 13 years old meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV） criteria for attention-deficit/hyperactivity disorder （ADHD）, and 30 gender- and age-matched normal children were enrolled. They were assessed with symptom assessment scale of the Chinese version of Swanson Nolan and Pelham, Version IV Scale-parent from （SNAP-AV） and semantic comprehension tests including the Vocabulary subtest of the Chinese version Wechsler Intelligence Scale for Children （C-WISC） and Peabody Picture Vocabulary Test （PPVT）. And they performed working memory tasks, inducling digital span, metal rotation and dot-matrix. Results： The scores of Vocabulary subtest [ （ 12. 2 ±2. 7） vs. （ 14.4 ±2. 9） ] and PPVT [ （ 112.3 ±9. 7） vs. （ 117.5 ±8）, P 〈0. 05] wree lower in ADHD chilfren than the controls. The scores of digital backward [（3.9 ±1.4） vs （5.1 ±1.7）, P 〈0. 05], mental rotation [（4. 9 ±1.8） vs （6. 0 ±1. 7）, P 〈0. 05] and dot-matrix [（2. 7 ±1.4） vs （3.5 ± 1.5）, P 〈 0. 05] were lower in ADHD children than the controls. There was no significant difference in the scores of the digital forward between the two groups （P 〉 0. 05）. The scores of Vocabulary subtest in ADHD children were positively correlated with the scores of mental rotation （r = 0.40, P 〈 0. 05）. There was no correlation between the scores of PPVT and tasks of working memory （P 〉 0. 05）. The scores of Attention-deficit, hyperactivity/impulsivity and total scores in ADHD group were negatively correlated with dot-matrix （ r = - 0. 56 ～ - 0. 60, P 〈 0. 05） . Conclusion： It suggests that ADHD children have semantic impairments as well as working memory deficits, and semantic comprehension may be closely related to the visual-spatial working memory.