广泛性发育障碍与注意力缺陷多动障碍的共病情况:一项回顾性病历审查结果
The comorbidity of Pervasive Developmental Disorder and Attention Deficit Hyperactivity Disorder: results of a retrospective chart review.
作者信息
Goldstein Sam, Schwebach Adam J
机构信息
University of Utah, USA.
出版信息
J Autism Dev Disord. 2004 Jun;34(3):329-39. doi: 10.1023/b:jadd.0000029554.46570.68.
OBJECTIVE
To determine if a sample of children meeting diagnostic criteria for a Pervasive Developmental Disorder (PDD) display symptoms and impairment related to Attention Deficit Hyperactivity Disorder (ADHD) sufficient to warrant a comorbid diagnosis of ADHD. Further, do children with PDD displaying such symptoms demonstrate more impairment in daily life activities than those children only having PDD?
METHOD
A retrospective chart review was conducted on children (N = 57) diagnosed with the PDD's of Autism or PDD-Not Otherwise Specified (PDD-NOS), or ADHD. Comparative analysis of questionnaire and neuropsychological test data was completed to determine the severity of ADHD-like symptoms presenting among children with PDD.
RESULTS
From the pool of subjects having PDD with sufficient data (N = 27), 7 or 26% met DSM-IV criteria for the combined type of ADHD. Nine or 33% met diagnostic criteria for the Inattentive Type of ADHD and 11 or 41% did not demonstrate a significant number of ADHD symptoms to warrant a comorbid diagnosis of ADHD. Results indicate that a subgroup of children with PDD displaying significant ADHD-like symptoms may in fact have ADHD thus warranting a comorbid diagnosis of ADHD. Current data did not suggest children with PDD and the combined type of ADHD demonstrated significantly more impairment in daily life functioning than those children only having PDD. However, this appeared likely the result of small sample size. The data, however, does indicate such children experience more difficulties in daily situations as rated by parents and teachers.
CONCLUSION
These findings reinforce clinical observations indicating that some children with PDD may also experience an independent comorbid condition of ADHD, suggesting that a comorbid diagnosis of ADHD with PDD be considered in such cases. If further findings are replicated, the current exclusionary DSM-IV-TR criteria of making such a comorbid diagnosis should be re-considered.
目的
确定符合广泛性发育障碍(PDD)诊断标准的儿童样本是否表现出与注意力缺陷多动障碍(ADHD)相关的症状和损害,足以证明可作出ADHD共病诊断。此外,表现出此类症状的PDD儿童在日常生活活动中的损害是否比仅患有PDD的儿童更大?
方法
对诊断为自闭症或未特定的广泛性发育障碍(PDD-NOS)或ADHD的儿童(N = 57)进行回顾性病历审查。完成问卷和神经心理学测试数据的比较分析,以确定PDD儿童中出现的ADHD样症状的严重程度。
结果
在有足够数据的PDD受试者群体(N = 27)中,7名或26%符合ADHD混合型的DSM-IV标准。9名或33%符合ADHD注意力不集中型的诊断标准,11名或41%未表现出大量ADHD症状,不足以作出ADHD共病诊断。结果表明,表现出显著ADHD样症状的PDD儿童亚组实际上可能患有ADHD,因此有理由作出ADHD共病诊断。目前的数据并未表明患有PDD和ADHD混合型的儿童在日常生活功能方面的损害比仅患有PDD的儿童显著更大。然而,这似乎可能是样本量小的结果。不过,数据确实表明,根据家长和教师的评定,此类儿童在日常情况下会遇到更多困难。
结论
这些发现强化了临床观察结果,表明一些PDD儿童可能也患有独立的ADHD共病情况,这表明在这种情况下应考虑PDD与ADHD共病的诊断。如果进一步的研究结果得到重复验证,则应重新考虑目前作出这种共病诊断的排除性DSM-IV-TR标准。