注意缺陷多动障碍儿童观点采择特征与执行功能的相关性

Characteristics of perspective-taking in children with attention deficit hyperactivity disorder and its correlation with executive function

目的对比分析注意缺陷多动障碍(attention deficit hyperactivity disorder, ADHD)儿童与正常儿童完成"观点-视角转换"任务时的差异, 并进一步探讨其观点采择功能受损与执行功能间的关联。方法 2019年1月至2020年12月, 依据DSM-5诊断标准纳入6~16岁的ADHD儿童32例(ADHD组), 以及年龄、智能匹配的正常发育儿童26例(TD组)。采用"观点-视角转换"任务范式测量两组被试的困境和探测阶段对自我推理、母亲观点采择和他人观点采择的反应时及正确率, 再由执行功能评定量表(the behavior rating inventory of executive function, BRIEF)评估其执行功能。应用重复测量方差分析比较两组被试在观点采择不同阶段反应时及正确率的差异;采用Pearson相关分析进一步探讨ADHD组异常的观点采择行为学特征与BRIEF总分及各量表分的相关性。结果与TD组相比, ADHD组BRIEF量表的总分及各分量表分均显著增高, 差异有统计学意义(均P<0.01)。在"观点-视角转换"任务困境阶段, 组别和任务类型交互作用显著[F(2, 106)=4.365, P<0.05]。简单效应分析显示, 在他人观点采择中, ADHD组反应时[(2 305.48±464.27)ms]较对照组[(1 971.13±462.95)ms]明显增长, 差异有统计学意义(t=2.870, P<0.01)。Pearson相关分析显示, ADHD组困境阶段对他人观点采择的反应时与执行功能中工作记忆、组织和抑制指数呈正相关(r=0.401、0.432、0.342, 均P<0.01)。结论 ADHD儿童他人观点采择能力与执行功能受损密切相关, 两者可能存在共同的神经心理学基础。

Objective To explore the differences between impaired perspective-taking and executive function in children with attention deficit hyperactivity disorder(ADHD).Methods From January 2019 to December 2020,according to DSM-5 diagnostic criteria,thirty-two cases of ADHD children aged 6 to 16(ADHD group)and twenty-six cases of typical development children and adolescents matched with age and intelligence(TD Group)were included.The response time and accuracy rate in dilemma stage and probe stage to self-oriented,maternal perspective-taking and other perspective-taking were measured using perspective-shifting task,and the executive function was evaluated by the behavior rating inventory of executive function(BRIEF).Repeated measurement analysis of variance was used to compare the difference of response time and accuracy rate between the two groups.Pearson correlation analysis was used to explore the correlation between the perspective-taking behavior characteristics and the BRIEF total score and subscale scores of ADHD group.Results The total score and subscale scores of BRIEF scale in ADHD group were significantly higher than those in TD group(all P<0.01).The interaction between group and task type was significant during the task dilemma stage of perspective-shifting task(F(2,106)=4.365,P<0.05).Simple effect analysis showed that in other-perspective-taking task,the response time of ADHD group((2305.48±464.27)ms)was significantly longer than that of TD group((1971.13±462.95)ms)and the difference was statistically significant(t=2.870,P<0.01).Pearson correlation analysis showed that the response time of ADHD group to other perspective-taking in dilemma stage was positively correlated with working memory,organization and inhibition index in EF(r=0.401,0.432,0.342,all P<0.01).Conclusion The ability of the perspective taking is closely related to impaired executive function,which seem to share a common neuropsychological basis.