儿童注意缺陷与破坏性行为障碍的8年随访研究

An 8-year follow-up study of children attention deficit and disruptive behavior disorder

目的探讨儿童注意缺陷与破坏性行为障碍(ADDBD)的自愈率、其他精神障碍的发生率及持续性。方法对2005年在河南唐河县22所小学中诊断出的ADDBD儿童,于8年后依据美国精神障碍诊断与统计手册第四版(DSM-IV)进行ADDBD及其他精神障碍的诊断。结果注意缺陷/多动障碍(ADHD)、对立违抗性障碍(ODD)、品行障碍(CD)、ADHD合并ODD(ADHD+ODD)及ADHD合并ODD合并CD(ADHD+ODD+CD)的自愈率分别为81.7%、65.0%、83.3%、44.4%及0,ADHD高于ODD(P<0.05)。ADHD、ODD及CD之间无诊断转换。ADHD、ODD、CD、ADHD+ODD及ADHD+ODD+CD其他精神障碍的发生率分别为11.7%、13.6%、33.3%、38.9%及50.0%,ADHD、ODD、CD及ADHD+ODD之间差异有统计学意义(P<0.05)。自愈率男女无明显差异,其他精神障碍发生率女性高于男性(P<0.05);进入成年期后27.78%的患者未愈。结论注意缺陷与破坏性行为障碍儿童自愈率高,其中ADHD较为明显;注意缺陷与破坏性行为障碍儿童出现其它精神障碍的发生率较高,其中女性和合并症者较为明显;儿童期ADDBD可能持续至成年期。

Objective To explore the self-healing rate,other psychiatric disorders incidence rate and symptoms persistence in children with attention deficit and disruptive behavior disorder （ADDBD）. Methods A return visit was performed and ADDBD or other psychiatric disorders were diagnosed using DSM-IV on children with ADDBD in Tanghe, Henan province in 2005 and 2013 respectively. Results The self-healing rates on attention deficit hyperactivity disorder （ ADHD ）, oppositional defiant disorder（ ODD）, character disorder（CD） ,ADHD ＋ ODD and ADHD ＋ ODD ＋ CD were 81.7% ,65.0% ,83.3% ,44.4% and 0 in 2013 respectively. The serf-healing rate was higher on ADHD than that on ODD （P 〈 0. 05 ）. There was no diagnosis conversion among ADHD, ODD and CD. The complications incidence rates on ADHD, ODD,CD,ADHD ＋ ODD,ADHD ＋ ODD ＋ CD were 11.7% ,13.6% ,33.3% ,38.9% and 50.0% in 2013 respectively . It was different on other psychiatric disorders incidence rates among ADHD, ODD, CD and ADHD ＋ ODD （ P 〈 0.05）. There was no gender difference on self-healing incidence rate. The other psychiatric disorders incidence rates in girls were higher than those in boys （ P 〈 0.05 ）. There were 27.78% ADDBD children persisting into adulthood. Conclusions The self-healing rate in ADDBD children is high, especially in children with ADHD. The other psychiatric disorders incidence rate is also high in ADDBD children, especially in girls, children with ADHD ＋ ODD or children with ADHD ＋ ODD ＋ CD. ADDBD in childhood could persist into adulthood.