Brain Sciences Institute, Swinburne University of Technology, Melbourne, Victoria, Australia.
PLoS One. 2012;7(9):e41407. doi: 10.1371/journal.pone.0041407. Epub 2012 Sep 12.
While the profiling of subtypes of Attention Deficit Hyperactivity Disorder (AD/HD) have been the subject of considerable scrutiny, both psychometrically and psychophysiologically, little attention has been paid to the effect of diagnoses comorbid with AD/HD on such profiles. This is despite the greater than 80% prevalence of comorbidity under the DSM-IV-TR diagnostic definitions. Here we investigate the event related potential (ERP) and psychometric profiles of Controls, AD/HD, and comorbid AD/HD (particularly AD/HD+ODD/CD) groups on six neurocognitive tasks thought to probe the constructs of selective and sustained attention, response inhibition and executive function. Data from 29 parameters extracted from a child group (age range 6 to 12; 52 Controls and 64 AD/HD) and from an adolescent group (age range 13 to 17; 79 Controls and 88 AD/HD) were reduced via a Principal Components Analysis, the 6 significant eigenvectors then used as determinants of cluster membership via a Two-Step Cluster Analysis. Two clusters were found in the analysis of the adolescent age group--a cluster dominated by Control and AD/HD participants without comorbidity, while the second cluster was dominated by AD/HD participants with externalising comorbidity (largely oppositional defiant/conduct disorder ODD/CD). A similar segregation within the child age group was not found. Further analysis of these objectively determined clusters in terms of their clinical diagnoses indicates a significant effect of ODD/CD comorbidity on a concurrent AD/HD diagnosis. We conclude that comorbid externalising behaviour in AD/HD constitutes a distinct pathological entity in adolescence.
虽然注意缺陷多动障碍（AD/HD）亚型的特征分析在心理测量学和心理生理学方面都受到了相当多的关注，但对于 AD/HD 合并诊断对这些特征的影响却很少关注。尽管根据 DSM-IV-TR 诊断标准，合并症的患病率超过 80%。在这里，我们研究了对照组、AD/HD 组和合并 AD/HD（特别是 AD/HD+ODD/CD）组在六个神经认知任务上的事件相关电位（ERP）和心理计量特征，这些任务被认为可以探测选择性和持续性注意、反应抑制和执行功能的结构。从儿童组（年龄范围 6 至 12 岁；52 名对照组和 64 名 AD/HD）和青少年组（年龄范围 13 至 17 岁；79 名对照组和 88 名 AD/HD）中提取的 29 个参数的数据通过主成分分析进行了简化，然后使用 6 个显著特征向量作为通过两步聚类分析确定聚类成员的决定因素。在对青少年年龄组的分析中发现了两个聚类——一个聚类主要由无合并症的对照组和 AD/HD 参与者组成，而第二个聚类主要由伴有外部化合并症（主要是对立违抗性/品行障碍 ODD/CD）的 AD/HD 参与者组成。在儿童年龄组中没有发现类似的隔离。根据其临床诊断对这些客观确定的聚类进行进一步分析表明，ODD/CD 合并症对同时发生的 AD/HD 诊断有显著影响。我们得出结论，AD/HD 中的合并性外化行为在青少年中构成了一种独特的病理实体。
