注意缺陷多动障碍男童精细动作技能与执行功能的关系

The relationship between fine motor skills and executive function in boys with attention deficit hyperactivity disorder

目的 探讨学龄期6~10岁注意缺陷多动障碍(ADHD)男童的精细动作技能和执行功能之间的关系,为促进ADHD男童执行功能的发展提供参考。方法 于2020年11月至2021年5月,从北京市某三甲医院和北京市某公立小学招募65名ADHD男童,按照年龄和性别匹配募集正常发育的65名男童为正常对照组。采用儿童动作协调能力标准评估工具(MABC-2)评估儿童精细动作技能,利用Stroop色词测验(SCWT)、Rey复杂图形测验(ROCFT)、连线测验(TMT)分别评估儿童的抑制控制、工作记忆和认知灵活性。采用独立样本t检验分析两组间的差异,利用Pearson相关分析和分层回归分析探讨ADHD男童精细动作技能和执行功能之间的关系。结果 在精细动作技能测试中,ADHD男童得分(8.68±3.62)低于正常男童(11.22±2.27)(t=4.80);在执行功能测试中,ADHD男童的SCWT、ROCFT、TMT测试结果均差于正常男童(t=-4.53~4.42)(P值均<0.05)。相关性分析显示,ADHD男童的精细动作技能得分与字义错误数(r=-0.35)、颜色错误数(r=-0.42)呈负相关,与延时结构(r=0.30)和细节(r=0.25)记忆得分呈正相关,与TMT-A反应时(r=-0.34)、TMT-B反应时(r=-0.26)、错误数(r=-0.43)呈负相关(P值均<0.05)。分层回归分析显示,ADHD男童的精细动作技能得分对抑制控制、工作记忆和认知灵活性的测试结果均有预测作用(P值均<0.05),解释率分别为15%,7%,19%。结论 ADHD男童的精细动作技能与执行功能有相关性,且精细动作技能可在一定程度上预测抑制控制、工作记忆和认知灵活性。可通过发展ADHD男童的精细动作技能来促进其执行功能的发展。

Objective To investigate the relationship between fine motor skills and executive function in school-aged boys with attention deficit hyperactivity disorder(ADHD)aged 6-10 years,so as to provide a reference for promoting executive function.Methods From November 2022 to May 2021,65 boys with ADHD were recruited from a tertiary hospital in Beijing and a public elementary school in Beijing,and 65 boys with typical development according to age and sex were recruited as controls.Children's fine motor skills were assessed using the movement assessment battery for children,second version(MABC-2),and children's inhibitory control,working memory,and cognitive flexibility were assessed using the Stroop color word test(SCWT),Rey osterrich complex figure test(ROCFT)and trail making test(TMT),respectively.Independent samples t-tests were used to analyze the differences between the two groups,and Pearson correlation analysis and stratified regression analysis were used to explore the relationship between fine motor skills and executive functioning in boys with ADHD.Results In the fine motor skills test,boys with ADHD scored significantly lower(8.68±3.62)than control boys(11.22±2.27)(t=4.80,P<0.05);in the executive function test,the results of SCWT,ROCFT,and TMT tests were significantly worse in boys with ADHD than in normal boys(t=-4.53-4.42,P<0.05).Correlation analysis showed that the fine motor skill scores of boys with ADHD were negatively correlated with the number of word sense errors(r=-0.35)and color errors(r=-0.42),and positively correlated with memory scores for delayed structure(r=0.30)and detail(r=0.25),which were negatively correlated with TMT-A(r=-0.34),TMT-B reaction time(r=-0.26),number of errors(r=-0.43)(P<0.05).Stratified regression analysis showed that fine motor skill scores of boys with ADHD were predictive of test results for inhibitory control,working memory and cognitive flexibility,with explanatory rates of 15%,7%,and 19%,respectively.Conclusion Fine motor skills in boys with ADHD are correlated with executive functions,and fine motor skills could predict inhibitory control,working memory and cognitive flexibility to some extent.The development of fine motor skills in boy with ADHD could promote their executive functions.