父母训练对注意缺陷多动障碍儿童疗效评价的Meta分析

Meta-analysis of efficacy of parent training for children with attention deficit hyperactivity disorder

目的分析父母训练(parent training,PT)对患有注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)或有ADHD症状儿童ADHD核心症状、行为问题和父母教养压力方面的有效性。方法在PsychINFO、PubMed、EMBASE、Web of Science、Scopus、中国知网、万方数据库、维普以及中国生物医学文献数据库检索父母训练对注意缺陷多动障碍及有相关特征儿童疗效的针对中国人群的随机对照试验,应用Cochrane随机试验偏倚工具的第2版对纳入研究进行质量评价,使用Review Manager 5.4.1绘制森林图,使用Stata 18.0软件对Meta分析结果进行敏感性分析,以评估结果的稳定性,使用漏斗图和Egger检验评估发表偏倚。结果共纳入10项研究,试验组总计571名被试,对照组562名被试。试验组与对照组在ADHD核心症状总体水平(MD=-2.43,95%CI:-3.95~-0.91)、注意缺陷维度(MD=-1.10,95%CI:-1.94~-0.26)以及多动/冲动维度(SMD=-0.58,95%CI:-0.87~-0.28)均差异具有统计学意义(均P<0.01)。试验组经父母训练后行为问题总体水平(SMD=-0.80,95%CI:-1.05~-0.55)、品行问题(SMD=-1.34,95%CI:-2.31~-0.37)、学习问题(SMD=-0.81,95%CI:-1.40~-0.23)、冲动/多动行为(SMD=-0.53,95%CI:-0.78~-0.29)和多动指数(SMD=-1.27,95%CI:-1.99~-0.55)低于对照组,差异具有统计学意义(均P<0.05)。试验组的教养压力总体水平(SMD=-0.69,95%CI:-1.12~-0.26)、困难儿童维度(MD=-1.96,95%CI:-3.44~-0.48)、亲子互动失调维度(MD=-3.10,95%CI:-4.43~-1.78)和育儿压力维度(MD=-3.35,95%CI:-4.59~-2.12)与对照组的差异具有统计学意义(均P<0.05)。试验组和对照组的对立违抗症状、焦虑问题和心身问题未观察到差异。结论在中国人群中,PT对于患有ADHD或有ADHD症状的儿童初步证明有效,增加PT比仅常规治疗更有效地改善了ADHD的核心症状(注意缺陷和多动/冲动)、行为问题以及父母的教养压力。

Objective To assess the efficacy of parent training(PT)on attention deficit hyperactivity disorder(ADHD)symptoms,behavioral problems,and parenting stress in child with ADHD or ADHD symptoms.Methods Randomized controlled trials of the effect of PT on ADHD symptoms in Chinese children with ADHD or ADHD symptoms were collected by PsychINFO,PubMed,EMBASE,Web of science,Scopus,China National Knowledge database,WanFang database,the China Science and Technology Journal Database and the China Biology Medicine disc.The quality of the included studies was evaluated by version 2 of the Cochrane tool for assessing risk of bias in randomized trial.Forest plots were drawn using Review Manager 5.4.1,sensitivity analyses of results were performed using Stata 18.0 to assess the stability of the results,and publication bias was assessed using funnel plots and Egger's test.Results A total of 10 studies containing 571 subjects in the experimental group and 562 subjects in the control group met the inclusion exclusion criteria.Significant differences were observed in various measures,including overall ADHD symptoms(MD=-2.43,95%CI:-3.95--0.91),inattention(MD=-1.10,95%CI:-1.94--0.26),hyperactivity/impulsivity(SMD=-0.58,95%CI:-0.87--0.28),overall conduct problems(SMD=-0.80,95%CI:-1.05--0.55),conduct problem(SMD=-1.34,95%CI:-2.31--0.37),learning problem(SMD=-0.81,95%CI:-1.40--0.23),impulsivity/hyperactivity(SMD=-0.53,95%CI:-0.78--0.29),hyperactivity index(SMD=-1.27,95%CI:-1.99--0.55),parenting stress index(SMD=-0.69,95%CI:-1.12--0.26),difficult child(MD=-1.96,95%CI:-3.44--0.48),dysfunctional interaction(MD=-3.10,95%CI:-4.43--1.78),and parenting distress(MD=-3.35,95%CI:-4.59--2.12)(all P<0.05).However,no significant differences were observed in oppositional-defiant disorder,anxiety,or somatic problem.Conclusions The initial findings suggested that PT was effective for Chinese children with ADHD or ADHD symptoms.The addition of PT appeared to improve core symptoms of ADHD(inattention and hyperactivity/impulsivity),conduct problems,and parental stress more effectively than routine care alone.