注意缺陷多动障碍学龄儿童执行功能与行为问题的相关性

Association between executive function and behavioral problems in school-age children with attention deficit hyperactivity disorder

目的探讨ADHD学龄儿童的执行功能障碍特点及其与儿童行为问题的相关性,为临床干预提供理论依据。方法选取常州市第一人民医院儿童心理科门诊2020年5—12月收治的ADHD患儿32例。另招募37例年龄性别相匹配的健康儿童。对所有受试者进行Stroop测试、数字广度测验(DST)和威斯康星卡片分类测试(WCST),家长填写Conners父母用症状问卷,比较两组间执行功能测试和问卷结果的差异,并分析结果之间的相关性。结果1)ADHD组的学习问题、冲动-多动、多动指数得分高于健康组,差异有统计学意义(t=4.44、2.63、2.51,P<0.05)。2)ADHD组DST测试顺背和倒背与健康组差异无统计学意义(t=1.84、0.26,P>0.05),而ADHD组的WCST持续性错误率高于健康组,差异有统计学意义(t=2.46,P=0.02)。ADHD组Stroop测试中卡片B正确数、卡片C正确数、干扰量正确数低于健康组,差异有统计学意义(t=2.81、4.67、3.86,P<0.05);ADHD组执行功能障碍发生率81.25%,健康组的执行功能障碍发生率43.24%,差异有统计学意义(χ^(2)=10.40,P<0.05);其中Stroop测试结果异常发生率(68.75%)显著增高。3)DST和WCST测试结果与Conners父母用症状问卷结果之间无相关性;而Stroop测试的卡片A测试时间、卡片C测试时间、干扰量耗时等与心身障碍指数、学习问题指数、冲动-多动指数、多动指数呈轻度相关(r=0.35~0.47,P<0.05)。4)Logistic回归分析显示持续性错误率、卡片C正确数是ADHD的独立预测因素(P<0.05)。工作特征曲线分析持续性错误率的曲线下面积(AUC)为0.743,卡片C正确数的AUC为0.783,Z值=0.491,P=0.624。持续性错误率对应值在4.23时约登指数最大为0.459(敏感度1.000,特异性0.459),卡片C正确数对应值在44.5时约登指数最大为0.498(敏感度0.811,特异性0.688)。结论ADHD学龄儿童的执行功能障碍发生率高,且与行为问题相关,执行功能测试可以作为ADHD诊断的辅助指标。

Objective To explore the characteristics of executive function in school-age children with attention deficit hyperactivity disorder(ADHD)and its correlation with behavioral problems,so as to provide a theoretical basis for clinical intervention.Methods Thirty-two children with ADHD admitted to the Outpatient Clinic of Child Psychology Department,The First People's Hospital of Changzhou from May 2020 to December 2020 were selected into this study.Meanwhile 37 healthy children matched by age and sex were recruited.The Stroop test,Digit Distance Test(DST)and Wisconsin Card Test(WCST)were used for assessment,and parents completed the Parent Symptom Questionnaire(PSQ).The differences in executive function tests and questionnaire results between the two groups were compared,and the correlation was analyzed.Results 1)The scores of learning problems,impulse-hyperactivity and hyperactivity index in ADHD group were significantly higher than those of healthy children(t=4.44,2.63,2.51,P<0.05).2)There was no statistically significant difference in the results of DST test between ADHD children and healthy children(t=1.84,0.26,P>0.05),while the rate of persistent error in WCST in ADHD children was significantly higher than that in healthy children(t=2.46,P=0.02).In the Stroop test,the positive numbers of card B,card C and interference of ADHD children were significantly lower than those in healthy children(t=2.81,4.67,3.86,P<0.05).The rate of executive function disorder in ADHD group and healthy group was 81.25%and 43.24%,respectively,and the difference was significantly different(χ^(2)=10.40,P<0.05),of which the rate of abnormal Stroop test result was significantly higher(68.75%).3)There was no significant correlation of DST and WCST test results with PSQ score;however,card A and card C test time of Stroop test,and interference amount time of the Stroop test were mildly correlated with the psychosomatic disorder index,learning problems index,impulsivity-hyperactivity index,and hyperactivity index(χ^(2)=0.35-0.47,P<0.05).4)Logistic regression analysis showed that the persistent error rate and the number of correct cards C were independent predictive factors for ADHD(P<0.05).The area under the curve(AUC)of the working characteristic curve for the persistent error rate and correct card C was 0.743 and 0.783,respectively(Z=0.491,P=0.624).The maximum Jorden index was 0.459(sensitivity 1.000,specificity 0.459)when the persistent error rate was 4.23 and the maximum Jorden index was 0.498 when the number of correct cards C was 44.5(sensitivity 0.811,specificity 0.688).Conclusions Executive dysfunction is highly prevalent in school-age children with ADHD and is associated with behavioral problems.Executive function tests can be used as an auxiliary indicator to the diagnosis of ADHD.