中国学前儿童注意缺陷多动障碍的临床特征分析

Clinical characteristics of Chinese preschoolers with attention-deficit/hyperactivity disorder

目的分析学前儿童注意缺陷多动障碍(attention deficit/hyperactivity disorder,ADHD)的临床特征。方法以符合美国《精神障碍诊断与统计手册(第5版)》诊断标准并经诊断性婴幼儿及学前儿童评估(diagnostic infant and preschool assessment,DIPA)访谈的326例ADHD学前儿童(4岁0个月~5岁11个月)作为研究对象,分为注意缺陷为主型、多动冲动为主型和混合型。使用学前儿童中文版SNAP评定量表(Chinese version of the Swanson,Nolan,and Pelham rating scale)、长处和困难问卷(strengths and difficulties questionnaire,SDQ)及家长动机问卷(parent motivational questionnaire)进行评定。结果326例ADHD学前儿童中,男孩271例,女孩55例,男女性别比为5∶1;ADHD亚型构成,混合型216例,多动冲动为主型81例,注意缺陷为主型29例,3种亚型的构成比约为7∶3∶1;110例(33.7%)存在共病,其中93例共病对立违抗性障碍(oppositional defiant disorder,ODD)。SDQ结果显示,69.0%的ADHD学前儿童存在伙伴问题;家长动机问卷结果提示,79.9%的家长有(强烈)改变的意愿。结论学前儿童ADHD,男孩多见,混合型为主,共病中对立违抗性障碍的比例最高;患病儿童的伙伴问题突出,家长有着强烈的治疗动机。

Objective To explore the clinical characteristics of preschoolers with attention-deficit/hyperactivity disorder(ADHD).Methods The subjects were 326 preschoolers(aged 4y0m5y11m),diagnosed as ADHD according to the diagnostic infant and preschool assessment(DIPA)from the Diagnostic and Statistical Manual of Mental Disorders(Fifth Edition)(DSM-5).The diagnoses of subtypes(ADHD-I,ADHD-HI,and ADHD-C)were made by DIPA.The Chinese version of SNAP for preschool children,the strengths and difficulties questionnaire(SDQ),and the parent motivational questionnaire were assessed.Results There were 271 boys and 55 girls in this study,with the ratio as 5∶1.There were 216 cases of ADHD-C,81 ADHD-HI,and 29 ADHD-I.The ratio of three subtypes was 7∶3∶1.And 110 ADHD preschoolers(33.7%)had comorbidity,with the majority of them suffering from oppositional defiant disorder(ODD),accounting for 28.5%(93 cases).The results of the SDQ(303 cases)indicated that 69.0%of the subjects had peer problems(209 cases).The results of the parental motivational questionnaire(253 cases)indicated that 202 parents(79.9%)had(strong)willingness to change.Conclusion There are more boys with ADHD in preschool age,most of them are ADHD-C subtypes,with mainly comorbidity as ODD.The preschoolers with ADHD have prominent peer problems,and the parents have strong motivation for treatment.