视听整合连续测试对不同年龄注意缺陷多动障碍儿童的诊断价值

Diagnostic value of integrated visual and auditory continuous performance test inchildren with attention deficit and hyperactivity disorder at different ages

目的探讨视听整合连续测试(integrated visual and auditory continuous performance test, IVACPT)对不同年龄注意缺陷多动障碍(attention deficit and hyperactivity disorder, ADHD)儿童的临床诊断价值。方法 对2021年3月—2022年7月因怀疑ADHD而就诊的604例6~16岁儿童,以《精神障碍诊断和统计手册(第5版)》(Diagnostic and Statistical Manual of Mental Disorders, 5th edition, DSM-5)作为诊断标准回顾性分析IVA-CPT的测评结果。将儿童按年龄分组,分析两种评估方式(DSM-5与IVA-CPT)的差异。结果 IVA-CPT诊断ADHD的灵敏度为60.00%~82.22%,特异度为51.28%~63.16%;两种评估方式在6~11岁各组中具有一般至中等的诊断一致性(Kappa=0.275~0.407, P<0.05)。IVA-CPT对各组儿童ADHD的分型结果显示:注意缺陷型的灵敏度为51.52%~75.00%,特异度为52.63%~68.89%;多动/冲动型的灵敏度为40.90%~66.67%,特异度为55.71%~92.16%;混合型的灵敏度为40.00%~62.50%,特异度为67.86%~91.38%。在6~10岁各组中,两种方式评估注意缺陷症状的一致性有统计学意义(Kappa=0.238~0.373,P<0.05);在6岁组,两种方式评估多动/冲动症状的一致性有统计学意义(Kappa=0.374,P<0.05)。结论 IVA-CPT适合用于6~10岁儿童的ADHD筛查,对11岁以上儿童需结合临床观察及其他测试结果综合判断。在分型诊断中,IVA-CPT对6~10岁注意缺陷型ADHD儿童有一定的辅助诊断价值;对11岁以上注意缺陷型ADHD、所有年龄多动/冲动型和混合型ADHD儿童,使用IVA-CPT评估时应谨慎判断。

Objective To investigate the diagnostic value of integrated visual and auditory continuous performance test(IVA-CPT)in children with attention deficit and hyperactivity disorder(ADHD)at different ages.Methods A total of 604 children aged 6 to 16 years with suspected ADHD from March 2021 to July 2022 were collected.The Diagnostic and Statistical Manual of Mental Disorders,5 th edition(DSM-5)was used as diagnostic criteria to retrospectively analyze the results of IVA-CPT.Children were grouped by age to compare the differences between the two evaluation methods(DSM-5 and IVA-CPT).Results The sensitivity of IVA-CPT was 60.00%-82.22%and the specificity was 51.28%-63.16%.There were average to moderate agreements between DSM-5 and IVA-CPT in the 6-11 years old groups(Kappa=0.275-0.407,P<0.05).The classification results of ADHD in each group by using IVA-CPT showed that the sensitivity of attention deficit type was 51.52%-75.00%and the specificity was 52.63%-68.89%;the sensitivity of hyperactivity/impulsivity type was 40.90%-66.67%and the specificity was 55.71%-92.16%;the sensitivity of combined type was 40.00%-62.50%and the specificity was 67.86%-91.38%.There were statistically general agreements between the two assessments in 6-10 years old groups with attention deficit type(Kappa=0.238-0.374,P<0.05)and in 6 years old group with hyperactivity/impulsivity type(Kappa=0.374,P<0.05).Conclusion IVA-CPT is suitable for screening ADHD in children aged 6-10 years.For children aged 11 and above,a comprehensive judgment should be made based on clinical observations and other test results.In classification diagnosis,IVA-CPT has certain auxiliary diagnostic value in children aged 6-10 years with attention deficit type. For children aged 11 and above with attention deficit type and children of all ages with hyperactivity/impulsivity and mixed ADHD, it should be cautious to use IVA-CPT assessment.