注意缺陷多动障碍患儿的临床症状及执行功能对自尊的影响

Study on the effects of clinical symptoms and executive function on self-esteem in children with attention deficit hyperactivity disorder

目的 探讨注意缺陷多动障碍(ADHD)患儿的临床症状、执行功能对自尊的影响。方法 选取2017年6月至2018年9月在上海市精神卫生中心儿少精神科门诊就诊的122例8~12岁ADHD患儿为研究组。同期选取上海市嘉定区某小学2~6年级的66名健康儿童为对照组。采用PiersHarris儿童自我意识量表(PHCSS)比较两组的自尊。采用斯诺佩评定量表(SNAP-Ⅳ)、Stroop色-词关联测试(SCWT)、韦氏儿童智力量表第四版(WISC-Ⅳ)调查研究组患儿的临床症状、执行功能。采用Pearson相关分析ADHD患儿PHCSS得分与临床症状及执行功的相关性,采用多重线性回归分析法对ADHD患儿自尊的影响因素进行分析。结果 研究组患儿PHCSS总分及各维度得分均低于对照组,差异均有统计学意义(t=-6.18~-2.24,P<0.01)。Pearson相关分析结果显示,ADHD患儿SCWT中的乙表正确数与PHCSS总分、合群维度评分、幸福与满足维度评分呈正相关(r=0.24、0.26、0.19;P<0.05),SNAP-Ⅳ中的多动/冲动与PHCSS中智力与学校情况维度评分、躯体与外貌属性维度评分呈正相关(r=0.19、0.23;P<0.05)。SNAP-Ⅳ中的多动/冲动和SCWT中的乙表正确读数是ADHD患儿自尊的影响因素(t=2.818、3.041;P<0.05)。结论 ADHD患儿自尊水平低于健康儿童,患儿的自尊水平受到多动/冲动症状、个体反应抑制能力的影响。

Objective To explore the impact of clinical symptoms and executive function on self-esteem in children with attention deficit hyperactivity disorder(ADHD).Methods From June 2017 to September 2018,a total of 122 children aged 8 to 12 years with ADHD who visited the pediatric clinic of Shanghai Mental Health Center were selected as the study group.At the same time,66 healthy children from grade 2 to grade 6 in a primary school in Jiading District of Shanghai were selected as the control group.Compare the selfesteem of the two groups using the Piers-Harris Children's Self-Concept Scale(PHCSS).The clinical symptoms and executive function of children in the study group were investigated using the Swanson Nolan and Pelham-Version IV(SNAP-IV),Stroop Color-Word Test(SCWT),and the Wechsler Intelligence Scale for Children Version IV(WISC-IV).Pearson correlation analysis was used to analyze the correlation between PHCSS scores,clinical symptoms,and executive performance in children with ADHD.Multiple linear regression was used to analyze the influencing factors of self-esteem in children with ADHD.Results The total score and scores of various dimensions of PHCSS in the study group were lower than those in the control group,and the differences were statistically significant(t=-6.18-2.24,P<0.01).The Pearson correlation analysis results showed that the correct reading of Table B in SCWT was positively correlated with the total score,social dimension score,and happiness and satisfaction dimension score of PHCSS(r=0.24,0.26,0.19;P<0.05),while hyperactivity impulse in SNAP-IV was positively correlated with the scores of intelligence and school situation dimensions,body and appearance ttribute dimensions in PHCSS(r=0.19,0.23;P<0.05).The hyperactivity impulses in SNAP-IV and the correct reading of Table B in SCWT are influencing factors for self-esteem in children with ADHD(t=2.818,3.041;P<0.05).Conclusions The level of self-esteem of ADHD children is lower than that of healthy children.The self-esteem level of ADHD children is affected by hyperactivity symptoms and the ability of individual response inhibition.