6~11岁不同亚型注意缺陷多动障碍儿童行为问题分析

Analysis of behavioral problems in children with different subtypes of attention deficit hyperactivity disorder aged 6-11 years

目的比较注意缺陷多动障碍(ADHD)三种亚型儿童的行为特征,为ADHD共患病二级预防提供参考。方法采用美国《精神障碍诊断与统计手册》(第五版)(DSM-V)诊断标准,将2019至2021年在四川省妇幼保健院确诊的500例6~11岁ADHD患儿分为注意缺陷为主型(ADHD-I)、多动/冲动型为主型(ADHD-HI)和混合型(ADHD-C)。通过儿童行为量表(CBCL)和Conners父母症状问卷比较不同性别、不同年龄段及各亚型的行为问题。结果ADHD-I中,女孩占比高于男孩,9~11岁组占比高于6~8岁组;而ADHD-HI及ADHD-C中,男孩高于女孩,6~8岁组高于9~11岁组,差异均有统计学意义(χ^(2)值分别为12.66、9.03,P<0.05);9~11岁组品行问题、心身问题、多动-冲动得分均高于6~8岁组,差异有统计学意义(t值分别为1.99、2.34、2.23,P<0.05);女孩活动能力、抑郁、躯体主诉、交往不良、内化行为问题得分高于男孩,违纪、分裂强迫、强迫性得分低于男孩,差异均有统计学意义(t值介于2.03~5.49之间,P<0.05);进一步按亚型分析,三种亚型均存在学习问题、心身问题、焦虑问题,且得分上无显著差异(P>0.05);ADHD-C多个行为问题因子(品行问题、冲动-多动、抑郁、违纪、攻击性、外化行为问题、强迫性、多动等)得分均高于其余两种亚型(F值介于3.48~20.06之间,P<0.05)。结论不同年龄、性别、亚型ADHD患儿的行为问题及社会功能损害不同;ADHD-C的行为问题更严重,社会适应能力更差。

Objective To compare the behavioral characteristics of children with three subtypes of attention deficit hyperactivity disorder(ADHD),and to provide reference for the secondary prevention of ADHD comorbidity.Methods According to the diagnostic criteria of American Diagnostic and Statistical Manual of Mental Disorders,(Fifth Edition)(DSM-V),500 children with ADHD aged 6-11 years who were diagnosed in Sichuan Maternal and Child Health Hospital from 2019 to 2021 were categorized into ADHD predominantly inattentive(ADHD-I),ADHD predominantly hyperactive-impulsive(ADHD-HI)and ADHD combined type(ADHD-C).Behavioral problems of different genders,ages and subtypes were compared by Child Behavior Check List(CBCL)and Conners Parental Symptom Questionnaire.Results In ADHD-I,the proportion of girls was higher than that of boys,and the proportion of 9-11 years old group was higher than that of 6-8 years old group.In ADHD-HI and ADHD-C,boys were higher than girls,and the 6-8 years old group was higher than that of the 9-11 years old group,the differences were statistically significant(χ^(2)=12.66 and 9.03,respectively,P<0.05).The scores of conduct problems,psychosomatic problems and hyperactive-impulsive in the 9-11 year old group were higher than those in the 6-8 year old group,and the differences were statistically significant(t=1.99,2.34 and 2.23,respectively,P<0.05).The scores of activity ability,depression,somatic complaints,bad communication and internalized behavior problems of girls were higher than those of boys,and the scores of violation of discipline,splitting compulsion and compulsion were lower than those of boys,and the differences were statistically significant(t ranged from 2.03 to 5.49,P<0.05).Further analysis by subgroup showed that all three subtypes had learning problems,psychosomatic problems and anxiety problems,and there was no significant difference(P>0.05).The scores of ADHD-C in several behavioral problem factors(conduct problem,impulsiveness-hyperactivity,depression,violation of discipline,aggression,externalized behavioral problem,compulsion,hyperactivity,etc.)were higher than those of the other two subtypes(F ranged from 3.48 to 20.06,P<0.05).Conclusion Children with ADHD of different ages,genders and subtypes have different behavioral problems and social function damage,ADHD-C has more severe behavior problems and poorer social adaptability.