注意缺陷多动障碍儿童粗大动作技能与执行功能发展的特点及关系

Characteristics and relationship between the development of gross motor skills and executive function in children with attention deficit hyperactivity disorder

目的探讨学龄期注意缺陷多动障碍(ADHD)儿童的粗大动作技能和执行功能的发展特点及其相关关系。方法2020年11月至2021年5月于北京大学第六医院和北京市海淀区万泉小学招募90例ADHD儿童,从该小学另募集年龄和性别匹配的正常发育儿童90例。采用儿童粗大动作发展测试量表第三版(TGMD-3)评估儿童的粗大动作技能,采用Stroop色词测验(SCWT)、Rey-Osterrich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。结果ADHD儿童TGMD-3得分显著低于正常儿童(t=-6.275,P<0.001),SCWT、ROCFT、TMT测试结果均差于正常儿童(|t|≥1.986,P≤0.05)。ADHD儿童的TGMD-3得分与字义反应时(r=-0.261)、字义错误数(r=-0.404)、颜色错误数(r=-0.326)呈负相关(P<0.05),与延时结构记忆得分(r=0.228)呈正相关(P<0.05),与TMT-A反应时(r=-0.255)、TMT-A错误数(r=-0.329)、TMT-B反应时(r=-0.214)、TMT-B错误数(r=-0.474)呈负相关(P<0.05)。分层线性回归分析显示,ADHD儿童的TGMD-3得分仅对抑制控制和认知灵活性的测试结果具有预测作用(P<0.05),解释率分别为8.7%和22.5%。结论ADHD儿童的粗大动作技能和执行功能均存在发育滞后,且两者之间有一定关联,其中,粗大动作技能水平可在一定程度上影响抑制控制和认知灵活性的发展。

Objective To investigate the developmental characteristics of gross motor skills and executive functions,and the correlation between them in school-age children with attention deficit hyperactivity disorder(ADHD).Methods From November,2020 to May,2021,90 children with ADHD were recruited from Peking University Sixth Hospital and Beijing Haidian Wanquan Primary School,and other 90 children with normal development from this primary school were recruited matched their age and gender.Gross motor skills were assessed with the Test of Gross Motor Development in Children,Third Edition(TGMD-3),and inhibitory control,working memory,and cognitive flexibility were assessed with Stroop Color Words Test(SCWT),Rey-Osterrich Complex Figure Test(ROCFT)and Trail Making Test(TMT),respectively.Results The TGMD-3 score was significantly lower in children with ADHD than in normal children(t=-6.275,P<0.001),while the test results of SCWT,ROCFT and TMT were worse(|t|≥1.986,P≤0.05).The TGMD-3 score of children with ADHD was negatively correlated with the word sense reaction time(r=-0.261),the number of word sense errors(r=-0.404)and the number of color errors(r=-0.326)(P<0.05),positively correlated with the delayed structural memory scores(r=0.228)(P<0.05),and negatively correlated with the TMT-A reaction time(r=-0.255),the number of TMT-A errors(r=-0.329),TMT-B reaction time(r=-0.214)and the number of TMT-B errors(r=-0.474)(P<0.05).Stratified linear regression analyses showed that the TGMD-3 score of children with ADHD was significant only in predicting test results for inhibitory control and cognitive flexibility(P<0.05),with explanations of 8.7%and 22.5%,respectively.Conclusion Developments of both gross motor skills and executive function delay in children with ADHD,and there is a relation between them,especially the level of gross motor skills relating to the developments of inhibitory control and cognitive flexibility.