注意缺陷多动障碍患儿多维计算机化执行功能训练的探索性随机对照研究

Multi-dimensional executive function by computer training in children with attention deficit hyperactivity disorder： a pilot randomized controlled trial

目的 探讨多维计算机化执行功能训练对注意缺陷多动障碍（attention deficit hyperactivity disorder,ADHD）患儿临床核心症状及执行功能的影响.方法 采用随机对照试验方法,纳入符合DSM-Ⅳ中ADHD诊断标准,智商≥80,年龄7～12岁的ADHD儿童共34例,简单随机分组方法分为多维执行功能训练组及工作记忆训练组,每组17例,分别接受持续12周（共60次,24 min/次）的多维计算机化执行功能训练或工作记忆训练.于第4、8、12周末采用ADHD评定量表-Ⅳ（ADHD Rating Scale-Ⅳ,ADHD RS-Ⅳ）父母版评估2组临床核心症状,执行功能行为评定量表父母版及线上执行功能评估项目评估2组执行功能,并采用重复测量方差分析进行组内各时间点疗效比较.结果经12周训练后,多维执行功能训练组与工作记忆训练组各项核心症状评分均显著降低,重复测量方差分析结果显示2组组内ADHD RS-Ⅳ父母版总量表评分差异均有统计学意义（F=15.624,P〈0.01;F=16.830,P〈0.01）,但组间差异无统计学意义;多维功能执行训练组的言语工作记忆（顺背F=5.044,P〈0.05;倒背F=7.453,P〈0.01）、空间工作记忆（F=8.319,P〈0.01）、视觉信息搜索（F=6.160,P〈0.05）得分均显著增加,工作记忆训练组仅空间工作记忆（F=3.662,P〈0.05）及视觉信息搜索（F=4.751,P〈0.01）得分显著增加,但组间差异无统计学意义.结论12周的多维执行功能训练和工作记忆训练可能改善ADHD儿童的临床症状及执行功能,且多维执行功能训练的效果可能优于工作记忆训练.

Objective To explore the effects of computerized executive function training on the clinical core symptoms and executive function of attention deficit hyperactivity disorder（ADHD）children by a randomized controlled trial.Methods Thirty-four cases diagnosed as ADHD according to the criteria of DSM-Ⅳ, aged 7 to 12 years, IQ≥80, were involved in the study. ADHD Rating Scale-Ⅳ （ADHD RS-Ⅳ）, Trail making test,online executive function test,Behavior Rating Inventory of Executive Function（BRIEF）, Chinese-Wechsler Intelligence Scale for Children were administered.The ADHD children were randomized into 2 groups. One of them accepted multi-dimensional executive function computer training and the other group accepted working memory training.Both groups needed to complete a 60 times,24 minutes per time training in 12 weeks.Results The scores of ADHD RS-Ⅳsignificantly decreased after 12-week trainings both in multi-dimensional executive function training group and working memory training group（F=15.624, P〈0.01, F=16.830,P〈0.01）. But there was no significant difference between the two groups（F=0.287,P〉0.05）. The scores of the online executive function test, significantly increased after 12-week trainings in multi-dimensional executive function training group in speech working memory （Serial F=5.044, P〈0.05;Reverse F=7.453, P〈0.01）, spatial working memory （F=8.319, P〈0.01） and rapidly visual information search scores（F=6.160,P〈0.05）while the working memory training group showed significant improvement in spatial working memory（F=4.751,P〈0.01）and rapidly visual information search scores（F=3.662, P〈0.05）. But there was no significant difference between the two groups. Conclusion Both the multi-dimensional executive function training and working memory training probably be effective on clinical core symptoms the clinical symptoms and executive function of ADHD children in 12 weeks,with the better effect of multi-dimensional executive function training.