与自主神经功能相关的外化和内化问题：一项针对青春期前儿童的基于人群的研究。
Externalizing and internalizing problems in relation to autonomic function: a population-based study in preadolescents.
作者信息
Dietrich Andrea, Riese Harriëtte, Sondeijker Frouke E P L, Greaves-Lord Kirstin, van Roon Arie M, Ormel Johan, Neeleman Jan, Rosmalen Judith G M
机构信息
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
出版信息
J Am Acad Child Adolesc Psychiatry. 2007 Mar;46(3):378-386. doi: 10.1097/CHI.0b013e31802b91ea.
OBJECTIVE
To investigate whether externalizing and internalizing problems are related to lower and higher heart rate (HR), respectively, and to explore the relationship of these problems with respiratory sinus arrhythmia (RSA) and baroreflex sensitivity (BRS). Moreover, to study whether problems present at both preschool and preadolescent age show stronger associations with autonomic function than those that were not.
METHOD
In a population cohort of 10- to 13-year-old children (N = 931; 11.6 +/- 0.5 years; 47% boys), autonomic measurements in supine and standing position were performed at school. RSA and BRS were determined by spectral analysis. Current externalizing and internalizing problems were assessed by the Child Behavior Checklist and problems at age 4 to 5 retrospectively by the Preschool Behavior Questionnaire.
RESULTS
At supine rest, current externalizing problems were associated with lower HR and higher RSA, but not with BRS and current internalizing problems with higher HR and lower RSA, but not with BRS. These results were specifically found in children with problems that were retrospectively reported to have been also present at preschool age. Standing-induced changes in autonomic parameters were unrelated to the behavioral dimensions.
CONCLUSIONS
Externalizing and internalizing problems are associated with divergent autonomic patterns, suggesting autonomic underarousal and overarousal, respectively. Problems starting early in life may specifically account for this. This should be confirmed in prospective studies.
目的
探讨外化问题和内化问题是否分别与较低和较高的心率（HR）相关，并探究这些问题与呼吸性窦性心律不齐（RSA）和压力反射敏感性（BRS）之间的关系。此外，研究在学龄前和青春期前均出现问题的儿童与自主神经功能的关联是否比未出现此类问题的儿童更强。
方法
在一个由10至13岁儿童组成的队列研究中（N = 931；11.6±0.5岁；47%为男孩），在学校对其仰卧位和站立位的自主神经指标进行测量。通过频谱分析确定RSA和BRS。采用儿童行为量表评估当前的外化和内化问题，通过学前行为问卷回顾性评估4至5岁时的问题。
结果
在仰卧休息时，当前的外化问题与较低的HR和较高的RSA相关，但与BRS无关；当前的内化问题与较高的HR和较低的RSA相关，但与BRS无关。这些结果在那些回顾性报告显示在学龄前也存在问题的儿童中尤为明显。站立引起的自主神经参数变化与行为维度无关。
结论
外化问题和内化问题与不同的自主神经模式相关，分别提示自主神经唤醒不足和唤醒过度。早年出现的问题可能是导致这种情况的原因。这一点应在前瞻性研究中得到证实。
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