Mulraney Melissa, Zendarski Nardia, Mensah Fiona, Hiscock Harriet, Sciberras Emma
1 Centre for Community Child Health, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.
2 Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
Aust N Z J Psychiatry. 2017 Apr;51(4):393-402. doi: 10.1177/0004867416659365. Epub 2016 Aug 20.
Irritable mood is common in children with attention-deficit/hyperactivity disorder. Research to date has primarily comprised cross-sectional studies; thus, little is known about the antecedents of irritability. Furthermore, existing cross-sectional studies generally focus on the association between irritability and comorbidities and do not examine broader aspects of functioning. Finally, previous research has neglected to include child-report of irritability. This study aimed to address these gaps using data from a longitudinal study of children with attention-deficit/hyperactivity disorder.
Children aged 5-13 years (mean = 10.2; standard deviation = 1.9) with attention-deficit/hyperactivity disorder were recruited from pediatric practices across Victoria, Australia. This study reports on those who had reached adolescence (12 years or older, mean = 13.8; standard deviation = 1.2) at the 3-year follow-up ( n = 140). Internalizing and externalizing problems were measured using the Strengths and Difficulties Questionnaire. At follow-up, parent-reported and adolescent self-reported irritability was assessed using the Affective Reactivity Index. Parent and adolescent outcomes measured at follow-up included attention-deficit/hyperactivity disorder symptom severity, sleep, behavior and parent mental health.
Children with externalizing problems at age 10 had higher parent-reported irritability (β = 0.31, 95% confidence interval = [0.17,-0.45], p = 0.001) in adolescence. Cross-sectional analyses found that irritability was associated with increased attention-deficit/hyperactivity disorder symptom severity and sleep problems; poorer emotional, behavioral and social functioning; and poorer parent mental health.
Our findings highlight the importance of assessing for and managing early conduct problems in children with attention-deficit/hyperactivity disorder, as these predict ongoing irritability which, in turn, is associated with poorer functioning across a number of domains.
易激惹情绪在注意力缺陷多动障碍儿童中很常见。迄今为止的研究主要包括横断面研究；因此，对于易激惹情绪的先兆知之甚少。此外，现有的横断面研究通常关注易激惹情绪与共病之间的关联，而未考察功能的更广泛方面。最后，以往的研究忽略纳入儿童对易激惹情绪的报告。本研究旨在利用对注意力缺陷多动障碍儿童的纵向研究数据来填补这些空白。
从澳大利亚维多利亚州的儿科诊所招募了5至13岁（平均 = 10.2；标准差 = 1.9）的注意力缺陷多动障碍儿童。本研究报告了在3年随访时已进入青春期（12岁或以上，平均 = 13.8；标准差 = 1.2）的儿童（n = 140）。使用长处和困难问卷来测量内化和外化问题。在随访时，使用情感反应指数评估家长报告的和青少年自我报告的易激惹情绪。随访时测量的家长和青少年结果包括注意力缺陷多动障碍症状严重程度、睡眠、行为和家长心理健康。
10岁时有外化问题的儿童在青春期有更高的家长报告的易激惹情绪（β = 0.31，95%置信区间 = [0.17, -0.45]，p = 0.001）。横断面分析发现，易激惹情绪与注意力缺陷多动障碍症状严重程度增加和睡眠问题有关；情绪、行为和社会功能较差；以及家长心理健康较差。
我们的研究结果强调了评估和管理注意力缺陷多动障碍儿童早期行为问题的重要性，因为这些问题预示着持续的易激惹情绪，而这反过来又与多个领域的功能较差有关。
