美国精神障碍诊断与统计手册第4版与国际疾病分类第10版诊断为多动综合征患儿的认知功能比较

Comparison of cognitive function between children with hyperactive disorder diagnosed by the 4th edition of Diagnostic and Statistical Manual of Mental Disorders and the 10th edition of International Classification of Diseases criteria

目的 比较美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)与国际疾病分类第10版(ICD-10)两种诊断标准诊断为多动综合征患儿的认知功能。方法 对至少符合一种诊断标准的连续282例患儿(其中同时符合两种诊断标准者共130例,仅符合DSM-Ⅳ中ADHD者152例)和94名正常对照儿童进行认知功能测查,并分低年龄段(≤9岁)、中年龄段(10～12岁)和高年龄段(>12岁)比较两患儿组及正常对照三组间认知功能的异同。结果(1)两患儿组韦氏智力测验、韦氏记忆测验和瑞文标准推理测验得分均低于对照组(P<0.01),但两患儿组之间的差异无显著性(P>0.05)。(2)Stroop测验中,低年龄段三组在完成时间、总错误数、字义干扰时差异有非常显著性(P<0.01);中年龄段在完成时间、字义干扰时差异有非常显著性(P<0.01);高年龄段仅完成时间差异有非常显著性(P<0.01)。(3)三组间的低、中年龄段在数字划消测验的总正确数、总遗漏数、总分、平均失误率以及倒背数字得分差异有非常显著性(P<0.01),而高年龄段的组间差异则无显著性(P>0.05)。结论 根据DSM-Ⅳ及ICD-10诊断的多动综合征患儿均存在认知功能损害。

Objective From a viewpoint of cognitive function, to explore the differences between DSM-Ⅳ and ICD-10 diagnostic criteria for ADHD. Methods Participants were children referred for symptoms of overactivity, inattention, and impulsivity. The ADHD children were classified into three subtypes according to DSM-Ⅳ criteria, and the symptom comorbidities assessed. The subjects were diagnosed according to ICD-10 hyperkinetic disorder criteria at the same time. All participants received a series of neuropsychological tests including the Chinese-Wechsler Intelligence Scale for Children (C-WISC), Wechsler Memory Scale (WMS) , number cancellation test, Stroop test and Raven's standard progressive matrices. Results Children meeting criteria for both DSM-IV ADHD and ICD-10 hyperkinetic disorder (ADHD/HKD group) were significantly younger than those for ADHD only[ ADHD group; (10. 2 ±2. 2) years vs. (10.9±2.3) years], suggesting an earlier referral age for ADHD/HKD children [(4.8±2.8) years vs. (5. 8±2.5)years]. As to the subtypes, a greater number of children in ADHD/HKD group met criteria for combined subtype (ADHD-C, 78.5%), whereas in ADHD group most met criteria for predominantly inattentive subtype ( ADHD-I, 82.9%). Few differences emerged on cognitive function between both the patient groups, though they all tended to have more cognitive impairments compared to normal children. Conclusions From a viewpoint of cognitive, we consider DSM-Ⅳ diagnostic criteria for ADHD is better than ICD-10.