Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
J Child Psychol Psychiatry. 2010 Aug;51(8):915-23. doi: 10.1111/j.1469-7610.2010.02217.x. Epub 2010 Feb 1.
BACKGROUND: The goal of this study was to investigate the occurrence, severity and clinical correlates of emotional lability (EL) in children with attention deficit/hyperactivity disorder (ADHD), and to examine factors contributing to EL and familiality of EL in youth with ADHD. METHODS: One thousand, one hundred and eighty-six children with ADHD combined type and 1827 siblings (aged 6-18 years) were assessed for symptoms of EL, ADHD, associated psychopathology and comorbid psychiatric disorders with a structured diagnostic interview (PACS) as well as parent and teacher ratings of psychopathology (SDQ; CPRS-R:L; CTRS-R:L). Analyses of variance, regression analyses, chi(2)-tests or loglinear models were applied. RESULTS: Mean age and gender-standardized ratings of EL in children with ADHD were >1.5 SD above the mean in normative samples. Severe EL (>75th percentile) was associated with more severe ADHD core symptoms, primarily hyperactive-impulsive symptoms, and more comorbid oppositional defiant, affective and substance use disorders. Age, hyperactive-impulsive, oppositional, and emotional symptoms accounted for 30% of EL variance; hyperactive-impulsive symptoms did not account for EL variance when coexisting oppositional and emotional problems were taken into account, but oppositional symptoms explained 12% of EL variance specifically. Severity of EL in probands increased the severity of EL in siblings, but not the prevalence rates of ADHD or ODD. EL and ADHD does not co-segregate within families. CONCLUSION: EL is a frequent clinical problem in children with ADHD. It is associated with increased severity of ADHD core symptoms, particularly hyperactivity-impulsivity, and more symptoms of comorbid psychopathology, primarily symptoms of oppositional defiant disorder (ODD), but also affective symptoms, and substance abuse. EL in ADHD seems to be more closely related to ODD than to ADHD core symptoms, and is only partly explainable by the severity of ADHD core symptoms and associated psychopathology. Although EL symptoms are transmitted within families, EL in children with ADHD does not increase the risk of ADHD and ODD in their siblings.
背景：本研究旨在调查注意缺陷多动障碍（ADHD）儿童情绪不稳（EL）的发生、严重程度和临床相关性，并探讨导致 EL 的因素以及 ADHD 青少年中 EL 的家族性。
方法：对 1186 名 ADHD 混合型儿童和 1827 名兄弟姐妹（年龄 6-18 岁）进行了 EL、ADHD、相关精神病理学和共患精神障碍的评估，使用结构化诊断访谈（PACS）以及父母和教师对精神病理学的评定（SDQ；CPRS-R:L；CTRS-R:L）。采用方差分析、回归分析、卡方检验或对数线性模型进行分析。
结果：ADHD 儿童的平均年龄和性别标准化 EL 评分高于正常样本的平均值 1.5 个标准差以上。严重 EL（>第 75 百分位）与更严重的 ADHD 核心症状相关，主要是多动冲动症状，以及更多共患对立违抗、情感和物质使用障碍。年龄、多动冲动、对立和情绪症状解释了 EL 变异的 30%；当同时考虑对立和情绪问题时，多动冲动症状不能解释 EL 的变异，但对立症状可以解释 12%的 EL 变异。先证者 EL 的严重程度增加了兄弟姐妹 EL 的严重程度，但不能增加 ADHD 或 ODD 的患病率。EL 和 ADHD 不在家庭中共同遗传。
结论：EL 是 ADHD 儿童常见的临床问题。它与 ADHD 核心症状的严重程度增加相关，尤其是多动冲动症状，以及更多共患精神病理学症状，主要是对立违抗障碍（ODD）症状，也包括情感症状和物质滥用。ADHD 中的 EL 似乎与 ODD 的关系比与 ADHD 核心症状的关系更密切，并且只能部分由 ADHD 核心症状和相关精神病理学的严重程度来解释。尽管 EL 症状在家庭中传递，但 ADHD 儿童的 EL 不会增加其兄弟姐妹患 ADHD 和 ODD 的风险。
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