共患对立违抗障碍的注意缺陷多动障碍儿童社会功能特征

Social functioning characteristics of children with co-occurrence of attention deficit hyperactivity disorder and oppositional defiant disorder

目的 探索共患对立违抗障碍(ODD)的注意缺陷多动障碍(ADHD)儿童社会功能特征,为改善ADHD儿童社会功能提供参考。方法 采用中文版注意缺陷多动障碍评定量表-父母版(SNAP-Ⅳ)、Weiss功能缺陷量表父母版(WFIRS-P)及儿童困难问卷(QCD),对首次就诊于珠海市妇幼保健院儿童心理卫生科的192名单纯ADHD儿童、243名共患ODD的ADHD儿童,以及珠海市某学校118名正常对照儿童进行评估分析。结果 3组儿童SNAP-Ⅳ量表注意缺陷因子得分分别为[1.9(1.7,2.1),1.8(1.6,1.9),1.0(0.6,1.2)],多动冲动因子得分分别为[1.8(1.4,2.1),1.6(1.1,1.8),0.7(0.2,1.0)],对立违抗因子得分分别为[1.6(1.5,1.9),1.0(0.8,1.1),0.8(0.5,1.0)],组间差异均有统计学意义(H值分别为268.44,237.97,418.66,P值均<0.01)。3组儿童WFIRS-P量表各维度及总分分别为家庭[0.8(0.6,1.1),0.6(0.3,0.8),0.3(0.1,0.6)];学习和学校[0.8(0.5,1.1),0.8(0.5,1.0),0.3(0.1,0.5)];生活技能[1.0(0.7,1.2),0.8(0.6,1.0),0.6(0.4,0.8)];自我管理[1.0(0.3,1.0),0.7(0.3,1.0),0.3(0.0,0.7)];社会活动[0.7(0.4,1.0),0.6(0.3,0.9),0.3(0.0,0.4)];冒险活动[0.3(0.2,0.5),0.2(0.1,0.4),0.1(0.0,0.2)];总分[0.8(0.6,1.0),0.6(0.5,0.8),0.4(0.2,0.6)],组间差异均有统计学意义(H值分别为108.82,122.45,60.17,40.58,96.17,76.57,138.30,P值均<0.01)。3组儿童QCD量表得分分别为[30.0(24.0,37.0),32.0(27.0,40.0),47.0(37.0,52.3)],组间差异有统计学意义(H=124.65,P<0.01)。多元线性回归分析结果表明,注意缺陷和对立违抗症状均是患儿WFIRS-P总分及QCD分的影响因素(R^(2)值分别为0.40,0.25,P值均<0.05)。结论 共患ODD的ADHD儿童在社会功能各个维度上的缺陷较ADHD儿童更为严重,社会功能缺陷受注意缺陷和对立违抗症状的影响。

Objective To explore the social functioning characteristics of children with co-ocurrence of attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) for intervention reference. Methods The Chinese Version of Swanson Nolan and Pelham, Version IV Scale-Parent Form(SNAP-IV), the Chinese Version of Weiss Functional Impairment Scale-Parent(WFIRS-P), and the Questionnaire-Children with Difficulties(QCD) were applied to 192 children with ADHD, 243 children with co-occurrence of ADHD and ODD, who firstly visited the Department of Children Psychological Health of Zhuhai Maternal and Child Health Care Hospital, and 118 healthy control children from a school in Zhuhai. Results The scores of attention deficit factor in SNAP-Ⅳ scale of children in three groups were[1.9(1.7, 2.1), 1.8(1.6, 1.9), 1.0(0.6, 1.2)], the scores of hyperactive impulsivity were[1.8(1.4, 2.1), 1.6(1.1, 1.8), 0.7(0.2, 1.0)] the scores of oppositional defiant were[1.6(1.5, 1.9), 1.0(0.8,1.1), 0.8(0.5, 1.0)], the differences were statistically significant(H=268.44, 237.97, 418.66, P<0.01). The dimensions and total scores of the three groups of children’s WFIRS-P scale were family[0.8(0.6, 1.1), 0.6(0.3, 0.8), 0.3(0.1, 0.6)];learning and school[0.8(0.5, 1.1), 0.8(0.5, 1.0), 0.3(0.1, 0.5)];life skills[1.0(0.7, 1.2), 0.8(0.6, 1.0), 0.6(0.4, 0.8)];self-management [1.0(0.3, 1.0), 0.7(0.3, 1.0), 0.3(0.0, 0.7)];social activities [0.7(0.4, 1.0), 0.6(0.3, 0.9), 0.3(0.0, 0.4)];adventure activities[0.3(0.2, 0.5), 0.2(0.1, 0.4), 0.1(0.0, 0.2)];the total score[0.8(0.6, 1.0), 0.6(0.5, 0.8), 0.4(0.2, 0.6)], the difference between the groups was statistically significant(H=108.82, 122.45, 60.17, 40.58, 96.17, 76.57, 138.30, P<0.01). The difference between the QCD scale scores of children in the three groups was statistically significant[30.0(24.0, 37.0), 32.0(27.0, 40.0), 47.0(37.0, 52.3), H=124.65, P<0.01). Multiple regression analysis showed that attention deficit, and oppositional defiant symptoms were associated with both the total WFIRS-P score and the QCD score of children(R^(2)=0.40, 0.25, P<0.05). Conclusion Children with co-occurrence of ADHD and ODD have more severe deficits in all dimensions of social functioning than children with ADHD, which might be associated with attention deficit and oppositional defiant symptoms.