抽动障碍患儿共患ADHD的影响因素及中介效应分析

Factors Associated with Comorbid ADHD in Children with Tic Disorders and Mediation Effect Analysis

目的分析抽动障碍(tic disorders,TD)患儿共患注意缺陷与多动障碍(attention deficit hyperactivity disorder,ADHD)的影响因素及路径关系中的中介效应。方法调查收集363例TD患儿的临床资料及人口学和家庭环境信息,采用多因素Logistic回归分析、路径分析及中介效应分析相结合的方法进行研究。结果放纵型家庭教养方式(OR=2.59)、TD病情中重度(OR=25.92)、合并行为问题(OR=3.72)是TD患儿共患ADHD的危险因素。中介效应分析结果显示,TD病情严重程度在TD诊断类型和合并行为问题之间起部分中介作用,中介效应大小为14.34%;TD合并行为问题在TD病情严重程度和共患ADHD之间起部分中介作用,中介效应大小为6.49%;TD合并行为问题在家庭教养方式和共患ADHD之间起部分中介作用,中介效应大小为24.14%。结论TD患儿共患ADHD与家庭环境、临床因素关系密切,在TD诊疗过程中应充分考虑到疾病本身、共患病以及中介变量的影响。

Objective To analyze the influencing factors associated with comorbid attention deficit hyperactivity disorder(ADHD)in children with tic disorders(TD)and the mediation effect in the path relationship.Methods The clinical data,demographic,and family environmental information of 363 children with TD were investigated and collected,and the study was carried out using multivariate Logistic regression analysis,path analysis,and mediation effect analysis.Results Parenting pattern of indulgence(OR=2.59),moderate/severe TD(OR=25.92),and combined behavioral problems(OR=3.72)were the risk factors for TD comorbid ADHD.The results of mediation effect analysis showed that TD severity partially mediated the association between TD type and behavioral problems,and the effect size was 14.34%;behavioral problems partially mediated the association between TD severity and comorbid ADHD,and the effect size was 6.49%;behavioral problems partially mediated the association between parenting pattern and comorbid ADHD,and the effect size was 24.14%.Conclusion TD with comorbid ADHD was closely associated with family environmental and clinical factors.In the process of TD diagnosis and treatment,the influence of the diseases themselves,comorbidities,and mediators should be fully considered.