Won Dana C, Guilleminault Christian, Koltai Peter J, Quo Stacey D, Stein Martin T, Loe Irene M
*Division of Neonatal and Developmental Medicine, Stanford University School of Medicine Palo Alto, California; †Sleep Medicine Division, Stanford University Palo Alto, California; ‡Division of Otolaryngology, Stanford University School of Medicine Palo Alto, California; §Division of Orofacial Sciences, UCSF School of Dentistry San Francisco, CA; ‖Department of Psychiatry, Stanford University San Francisco, CA; ¶Division of Academic General Pediatrics and Developmental Behavioral Pediatics University of California San Diego, Rady Chilidren's Hospital San Diego, CA; **Division of Neonatal and Developmental Medicine, Stanford University School of Medicine Palo Alto, California.
J Dev Behav Pediatr. 2017 Feb/Mar;38(2):169-172. doi: 10.1097/DBP.0000000000000386.
Carly is a 5-year-old girl who presents for an interdisciplinary evaluation due to behaviors at school and home suggestive of attention-deficit hyperactivity disorder (ADHD). Parent report of preschool teacher concerns was consistent with ADHD. Psychological testing showed verbal, visual-spatial, and fluid reasoning IQ scores in the average range; processing speed and working memory were below average. Carly's behavior improved when her mother left the room, and she was attentive during testing with a psychologist. Tests of executive function (EF) skills showed mixed results. Working memory was in the borderline range, although scores for response inhibition and verbal fluency were average. Parent ratings of ADHD symptoms and EF difficulties were elevated.Carly's parents recently separated; she now lives with her mother and sees her father on weekends. Multiple caregivers with inconsistent approaches to discipline assist with child care while her mother works at night as a medical assistant. Family history is positive for ADHD and learning problems in her father. Medical history is unremarkable. Review of systems is significant for nightly mouth breathing and snoring, but no night waking, bruxism, or daytime sleepiness. She has enlarged tonsils and a high-arched palate on physical examination.At a follow-up visit, parent rating scales are consistent with ADHD-combined type; teacher rating scales support ADHD hyperactive-impulsive type. Snoring has persisted. A sleep study indicated obstructive sleep apnea. After adenotonsillectomy, Carly had significant improvement in ADHD symptoms. She developed recurrence of behavior problems 1 year after the surgery.
卡莉是一名5岁女孩，因在学校和家中出现的行为表现提示注意力缺陷多动障碍（ADHD）而前来接受多学科评估。家长报告的幼儿园老师的担忧与ADHD相符。心理测试显示，言语、视觉空间和流体推理智商得分处于平均范围；处理速度和工作记忆低于平均水平。当卡莉的母亲离开房间时，她的行为有所改善，并且在接受心理学家测试时注意力集中。执行功能（EF）技能测试结果不一。工作记忆处于临界范围，尽管反应抑制和言语流畅性得分处于平均水平。家长对ADHD症状和EF困难的评分较高。卡莉的父母最近分居了；她现在和母亲住在一起，周末去看父亲。在她母亲晚上做医疗助理工作时，多个教养方式不一致的照顾者帮忙照顾孩子。家族病史显示她的父亲患有ADHD和学习问题。病史无异常。系统回顾显示有夜间张口呼吸和打鼾，但没有夜醒、磨牙或白天嗜睡。体格检查发现她扁桃体肿大且腭弓高。在一次随访中，家长评定量表与ADHD混合型相符；教师评定量表支持ADHD多动冲动型。打鼾持续存在。一项睡眠研究表明存在阻塞性睡眠呼吸暂停。腺样体扁桃体切除术后，卡莉的ADHD症状有了显著改善。术后1年，她的行为问题复发。
