| 杨燕平,李思迅,王美雯,王卓,刘沛,罗婷婷,陶煜杰,黄颐.伴情绪失调的注意缺陷多动障碍患儿执行功能与临床特征[J].四川精神卫生杂志,2024,37(4):307-311.Yang Yanping,Li Sixun,Wang Meiwen,Wang Zhuo,Liu Pei,Luo Tingting,Tao Yujie,Huang Yi,Executive function and clinical characteristics in children with attention-deficit hyperactivity disorder and emotional dysregulation[J].SICHUAN MENTAL HEALTH,2024,37(4):307-311 |
| 伴情绪失调的注意缺陷多动障碍患儿执行功能与临床特征 |
| Executive function and clinical characteristics in children with attention-deficit hyperactivity disorder and emotional dysregulation |
| 投稿时间：2024-04-23 |
| DOI：10.11886/scjsws20240423002 |
| 中文关键词: 注意缺陷多动障碍 情绪失调 临床特征 执行功能 |
| 英文关键词:Attention-deficit/hyperactivity disorder Emotional dysregulation Clinical symptoms Executive function |
| 基金项目:四川大学华西医院学科卓越发展1·3·5工程临床研究孵化项目（项目名称：基于虚拟现实技术的儿童注意力评估与训练平台的研发，项目编号：2018HXFH045） |
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| 中文摘要: |
| 背景 伴情绪失调的注意缺陷多动障碍（ADHD）可能是ADHD的一种特殊亚型，其共病焦虑障碍或抑郁障碍的风险更高，临床预后更差，有必要探索其独特的执行功能特征及临床特征。目前，将ADHD患儿分为伴与不伴情绪失调者并分析其临床特征与执行功能的研究有限。目的 探索伴情绪失调的ADHD患儿执行功能与临床特征。方法 纳入2020年6月—2023年12月在四川大学华西医院心理卫生中心门诊就诊的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的7~12岁ADHD患儿118例。采用Achenbach儿童行为量表（CBCL）进行评定，以CBCL中的焦虑/抑郁、攻击性行为、注意问题三个分量表评分之和的T分数，将ADHD患儿分为伴情绪失调组（n=68）和不伴情绪失调组（n=50）。采用中文版注意缺陷多动障碍SNAP-Ⅳ评定量表-父母版（SNAP-IV）、中国修订韦氏儿童智力量表（C-WISC）及Weiss功能缺陷量表父母版（WFIRS-P）分别评定患儿核心症状、智力水平及功能受损情况。采用剑桥神经心理自动化成套测试（CANTAB）中的4个测试评定执行功能：①剑桥球袋测试（SOC）评定空间计划能力；②目标内外注意转换（IED）评定认知灵活度，以完成阶段错误数量为指标；③空间工作记忆（SWM）评定空间工作记忆；④快速视觉信息处理（RVP）评定持续注意力。结果 伴情绪失调组SNAP-IV注意缺陷、多动/冲动、对立违抗分量表评分及总评分均高于不伴情绪失调组（t=3.206、5.088、6.316、6.553，P均<0.01）。伴情绪失调组WFIRS-P家庭、学习/学校、生活技能、自我观念、社交活动、冒险活动分量表评分及总评分均高于不伴情绪失调组（t=6.074、4.406、4.143、3.984、6.575、6.662、8.254，P均<0.01）。伴情绪失调组CANTAB中的IED任务中的完成阶段错误数量高于不伴情绪失调组（t=2.168，P<0.05）。结论 伴情绪失调的ADHD患儿核心症状及社会功能受损更严重，执行功能中的认知灵活度更差。 |
| 英文摘要: |
| Background Comorbid attention-deficit/hyperactivity disorder （ADHD） and emotional dysregulation may represent a distinct subtype of ADHD， which is characterized by an increased risk of anxiety or depressive disorder and a poor clinical prognosis， so research is urgently required to explore its unique executive functioning profile and clinical characteristics. However， there is limited research comparing the clinical symptoms and executive function in children with ADHD in terms of the presence or absence of emotional dysregulation.Objective To explore the executive function and clinical characteristics of ADHD children with emotional dysregulation.Methods From June 2020 to December 2023， 118 children aged 7 to 12 with ADHD attending the Mental Health Center of West China Hospital， Sichuan University and fulfilling the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria were enrolled. Children were classified into emotional dysregulation group （n=68） and non-emotional dysregulation group （n=50） based on the standard T-scores of Achenbach's Child Behavior Checklist （CBCL）- anxious/depressed， aggressive behavior and attention problems subscales. All children were then subjected to complete the Chinese version of Swanson Nolan and Pelham，Version IV Scale-parent form （SNAP-IV）， Chinese Wechsler Intelligence Scale for Children （C-WISC）， Weiss Functional Impairment Scale-Parent form （WFIRS-P） and 4 tests of the Cambridge Neuropsychological Test Automated Battery （CANTAB）： ①Stockings of Cambridge （SOC） testing spatial planning. ②Intradimensional-extradimensional Set Shifting（IED） testing cognitive/attentional flexibility， adjusting the total errors across the task. ③Spatial Working Memory （SWM） testing spatial working memory. ④Rapid Visual Information Processing （RVP） testing sustained attention.Results The SNAP-IV Inattention， Hyperactivity/Impulsivity and Oppositional Defiant Disorder domain scores and total score were all higher in emotional dysregulation group compared with non-emotional dysregulation group （t=3.206， 5.088， 6.316， 6.553， P<0.01）. The WFIRS-P family， school learning， life skills， self-concept， social activities and risky activities domain scores and total score were all higher in emotional dysregulation group compared with non-emotional dysregulation group （t=6.074， 4.406， 4.143， 3.984， 6.575， 6.662， 8.254， P<0.01）. In CANTAB， emotional dysregulation group made more total adjusted errors across the IED task compared with non-emotional dysregulation group （t=2.168， P<0.05）.Conclusion Children with ADHD who exhibit emotional dysregulation have been observed to experience more severe core symptoms， impaired social functioning and poorer performance on tests assessing executive function， particularly in the area of cognitive flexibility. ［Funded by 1·3·5 Project for Disciplines of Excellence-Clinical Research Incubation Project， West China Hospital， Sichuan University （number， 2018HXFH045）] |
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