抽动障碍患儿的临床特点及家庭功能、家庭关系、家庭教育方式现状

Clinical Characteristics,Family Function,Family Relationship and Family Education Mode of Children with Tic Disorder

目的:探讨抽动障碍患儿的临床特点及家庭功能、家庭关系、家庭教育方式现状。方法:以方便抽样法抽取2020年2月-2022年9月在中山市人民医院心理科门诊和儿科门诊就诊的抽动障碍患儿32例作为研究组。根据性别、年龄匹配,以1∶1的比例抽取32例本市健康儿童作为对照组。记录研究组患儿的一般资料,比较三种类型抽动障碍(短暂性抽动障碍、慢性抽动障碍、Tourette综合征)患儿的性别、年龄分布情况及共病情况(注意缺陷多动障碍、情绪障碍、睡眠障碍、学习困难、破坏性行为),并用耶鲁综合抽动严重程度量表(YGTSS)评价疾病严重程度。比较两组家庭功能评定量表(FAD)、家庭亲密度和适应性量表第二版(FACES-Ⅱ)、父母养育方式评价量表(EMBU)评分,分析家庭功能、家庭关系及家庭教育方式现状。结果:32例患儿中短暂性抽动障碍4例(12.50%)、慢性抽动障碍8例(25.00%)、Tourette综合征20例(62.50%)。三种类型抽动障碍患儿性别、年龄比较,差异均无统计学差异(P>0.05);Tourette综合征的伴共病比例明显高于短暂性和慢性抽动障碍(P<0.05),而短暂性和慢性抽动障碍的伴共病比例比较,差异无统计学意义(P>0.05)。Tourette综合征的YGTSS评分显著高于短暂性和慢性抽动障碍(P<0.05),慢性抽动障碍的YGTSS评分显著高于短暂性抽动障碍(P<0.05)。研究组问题解决、沟通、角色、情感反应、情感介入、行为控制、总的功能评分均低于对照组(P<0.05);研究组实际亲密度、实际适应性、理想亲密度、理想适应性均低于对照组,亲密度差高于对照组(P<0.05),但两组适应性差评分比较,差异无统计学意义(P>0.05);研究组父亲情感温暖与理解评分低于对照组(P<0.05),惩罚与严厉、过分干涉、拒绝与否认评分均高于对照组(P<0.05);研究组母亲情感温暖与理解评分低于对照组(P<0.05),拒绝与否认、惩罚与严厉评分均高于对照组(P<0.05);两组父亲偏爱被试、过度保护和母亲过分干涉与过度保护、偏爱被试评分比较,差异均无统计学意义(P>0.05)。结论:抽动障碍以Tourette综合征病情最复杂。抽动障碍儿童存在不良家庭环境和教育方式。不良的家庭环境和教育方式可能是此病作用的中间介质,临床应结合患儿的临床特点及不良家庭环境和教育方式进行有针对性的干预。

Objective:To explore the clinical characteristics,family function,family relationship and family education mode of children with tic disorder.Method:A total of 32 children with tic disorder who were admitted to the Outpatient Department of Psychology and Pediatrics,Zhongshan City People's Hospital from February 2020 to September 2022 were selected as the study group using convenient sampling method.According to the matching of gender and age,32 healthy children in this city were selected as the control group at a ratio of 1∶1.The general data of children in the study group were recorded,and the gender,age distribution,and comorbidity condition(attention deficit and hyperactive disorder,mood disorder,sleep disorder,learning difficulty and disruptive behavior)of children with three types of tic disorder(transient tic disorder,chronic tic disorder and Tourette syndrome)were compared,and the severity of the disease was evaluated by Yale global tic severity scale(YGTSS).The scores of family assessment device(FAD),family adaptability cohesion environment scale second edition(FACES-Ⅱ)and egma minnen bardndoms uppforstran(EMBU)were compared between the two groups,and the status quo of family function,family relationship and family education mode was analyzed.Result:Among the 32 children,there were 4 cases(12.50%)of transient tic disorder,8 cases(25.00%)of chronic tic disorder and 20 cases(62.50%)of Tourette syndrome.There were no statistical differences in gender and age among children with three types of tic disorder(P>0.05).The comorbidity rate of Tourette syndrome were significantly higher than those of transient and chronic tic disorder(P<0.05),but there was no significant difference between transient and chronic tic disorder(P>0.05).The YGTSS score of Tourette syndrome was significantly higher than those of transient and chronic tic disorder(P<0.05),the YGTSS score of chronic tic disorder was significantly higher than that of transient tic disorder(P<0.05).The problem solving,communication,role,emotional response,emotional intervention,behavior control and overall functional scores of the study group were lower than those of the control group(P<0.05).The scores of actual intimacy,actual adaptability,ideal intimacy,ideal adaptability in the study group were lower than those in the control group,and the intimacy difference was higher than that of the control group(P<0.05),but there was no statistical difference between the two groups in the score of adaptability difference(P>0.05).The scores of father's emotional warmth and understanding in the study group were lower than those in the control group(P<0.05),and the scores of punishment and severity,excessive interference,rejection and denial were higher than those in the control group(P<0.05).The scores of emotional warmth and understanding of mothers in the study group were lower than those in the control group(P<0.05),and the scores of rejection and denial,punishment and severity were higher than those in the control group(P<0.05).There were no significant differences the scores of between the two groups in father's favoring subjects,excessive protection and mother's excessive interference and protection and favoring subjects(P>0.05).Conclusion:Tourette syndrome is the most complicated tic disorder.Children with tic disorder have bad family environment and educational methods.Bad family environment and educational methods may be the intermediate media of the disease,and clinical intervention should be carried out in combination with the clinical characteristics of children,bad family environment and educational methods.