父母行为训练联合药物对儿童注意缺陷多动障碍长期疗效的随机单盲对照研究

Single-blind Randomized Controlled Study on Long-term Outcomes of Behavioral Parent Programs Combined with Medication in Children with Attention Deficit Hyperactivity Disorder.

目的探讨父母行为训练联合药物治疗对儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)与单纯使用药物的长期疗效差异,为ADHD的治疗提供依据。方法采用随机单盲对照研究方法,选取2019年9月~2020年7月在温州市人民医院儿童保健科门诊就诊的ADHD患儿60例,按照随机数字表法将其分为联合治疗组和单纯药物组,每组各30例。两组均给予盐酸托莫西汀治疗,联合治疗组在药物治疗的同时进行父母行为训练,采用SNAP-Ⅳ量表及韦氏智力测试评定患儿核心症状及认知功能改善情况,比较两组治疗3个月及治疗1年后的疗效。结果最终55例患儿完成本次研究,其中联合治疗组27例,单纯药物组28例。治疗3个月时,两组患儿SNAP-Ⅳ量表评分及韦氏智力测试得分比较,差异均无统计学意义(P均>0.05);治疗1年后,联合治疗组仍保持稳定疗效,SNAP-Ⅳ量表评分及韦氏智力测试得分与3个月比较,差异均无统计学意义(P均>0.05);单纯药物组1年后SNAP-Ⅳ量表评分比3个月升高,韦氏智力测试得分降低,差异均有统计学意义(P均<0.05);治疗1年后,联合治疗组SNAP-Ⅳ量表评分低于单纯药物组,韦氏智力测试得分高于单纯药物组,差异均有统计学意义(P均<0.05)。结论父母行为训练联合药物治疗能有效改善儿童ADHD的核心症状及认知功能,长期疗效显著,值得临床推广。

Objective To explore the difference of long-term outcomes between behavioral parent programs combined with medication and simple medication in children with attention deficit hyperactivity disorder(ADHD),and to provide evidence for the treatment of ADHD.Methods A total of 60 children with ADHD who were treated in the Child Health Outpatient of Wenzhou People′s Hospital between September 2019 and July 2020 were included for a randomized single-blinded controlled study.In the study,they were randomized into combination treatment group and simple medication group,30 children in each group.Both groups were given atomoxetine hydrochloride,and the combination treatment group received behavioral parent programs at the same time.SNAP-Ⅳscale and Wechsler Intelligence Scale were used for evaluating the core symptoms and cognitive functions of children,and the outcomes of 3 months and 1 year after treatment were compared between the two groups.Results A total of 55 children completed the study,including 27 in the combination treatment group and 28 in the simple medication group.According to a comparison of scores based on SNAP-Ⅳscale and Wechsler Intelligence Scale 3 months after treatment between the two groups,the differences were not statistically significant(P>0.05).For 1 year after treatment,the conditions of the combination treatment group remained stable,without statistical significance for the differences of scores based on SNAP-Ⅳscale and Wechsler Intelligence Scale as compared with 3 months after treatment(P>0.05),while for the simple medication group,compared with 3 months after treatment,the score based on SNAP-Ⅳscale 1 year after treatment increased,but the score based on Wechsler Intelligence Scale 1 year after treatment decreased,and the differences were statistically significant(P<0.05).For 1 year after treatment,the score based on SNAP-Ⅳscale in the combination treatment group was lower than that in the simple medication group,while the score based on Wechsler Intelligence Scale in the combination treatment group was higher than that in the simple medication group,the differences were statistically significant(P<0.05).Conclusion Behavioral parent programs combined with medication can effectively improve the core symptoms and cognitive functions of children with ADHD,and the long-term outcomes is significant,and therefore,it is worth popularizing clinically.