单纯注意缺陷多动障碍儿童学习能力的特征

The characteristics of learning abilities in children with pure attention-deficit/hyperactivity disorder

目的探讨单纯注意缺陷多动障碍（attention-deficit/hyperactivity disorder，ADHD）患儿各维度学习能力的特点。方法采用横断面研究，纳入ADHD患儿75例（ADHD组）和性别、年龄、年级与之相匹配的健康对照者25名（对照组）。采用修订韦氏智力测验、瑞文推理测验、自适应数学问题解决、自适应阅读能力、简单减法、复杂减法及词语辨析等测验，评估2组韦氏智力、推理能力、数学能力、阅读能力、计算流畅性及语义理解力。采用注意缺陷多动障碍评定量表-Ⅳ评估ADHD患儿的注意缺陷、多动冲动症状的严重程度。以瑞文推理测验成绩为协变量，比较2组之间学习能力的差异；采用Pearson相关分析、Spearman相关分析，检验ADHD患儿学习能力与症状之间的相关性。结果ADHD组各维度学习能力测试成绩（分）均低于对照组[自适应数学问题解决测验：8（43，0）与14（39，2），Z=-2.22，P=0.03；自适应阅读能力测验：10（35，0）与20（36，0），Z=-2.96，P=0.03；减法均值：17.6±9.4与27.1±10.0，t=4.29，P〈0.01，词语辨析：15.6±10.2与25.0±12.9，t=3.75，P〈0.01]，2组间差异均具有统计学意义。各维度学习能力与注意缺陷量表分、多动冲动量表分不具有相关性（均P〉0.05）。结论单纯ADHD患儿计算流畅性、数学问题解决能力、阅读理解能力、词语辨析能力等维度的学习能力均低于健康儿童。不同维度学习能力与ADHD症状可能不具有相关性。

Objective To explore the characteristics of various learning abilities in children with pure attention-deficit/hyperactivity disorder（ADHD）. Method A cross-sectional study was used. Seventy-five children with pure ADHD and 25 normal children with gender-, age- and grade-matched to ADHD children were enrolled. Each subject was tested by the China-Wechsler Intelligence Scale （C-WISC）, Raven＇s standard progressive matrices, graded mathematical achievement, graded reading achievement, simple subtraction, complex subtraction and word semantics for their IQ, reasoning ability, the best level of mathematical and reading achievement, computation fluency and language comprehension. The ADHD Rating Scale-IV was used to assess the symptoms of inattention and hyperactive impulsive in children with ADHD. The scores of Raven＇s standard progressive matrices were used as a eovariate, and to compare the differences of learning abilities between both groups. Pearson correlation analysis and Spearman correlation analysis were used to test the association between learning abilities and symptoms in children with ADHD. Result Different aspects of learning abilities of ADHD group were lower than those of control group, and there were significant differences between two groups （all P〈0.05）, with the scores of graded mathematical achievement of（ 8 （43, 0） vs. 14 （39,2）, Z=-2.22, P=0.03）, the scores of graded reading achievement were （10 （35, 0） vs. 20 （36, 0）, Z=-2.96, P=0.03）, the scores of subtraction of （17.6±9.4 vs. 27.1 ± 10.0, t=4.29, P〈 0.01）, and the scores of word semantics of （15.6 ± 10.2 vs. 25.0 ± 12.9, t=3.75, P〈0.01）. There was no correlation between all learning abilities and the scores of ADHD Rating Scale-IV （all P〉0.05）. Conclusion The computation fluency, graded mathematical achievement, graded reading achievement and word semantics of children with pure ADHD may be lower than normal control children. Different learning abilities may not be related to symptoms of ADHD.