Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, Graduate Institute of Clinical Medicine, Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 2017 Dec;116(12):946-955. doi: 10.1016/j.jfma.2017.02.009. Epub 2017 Mar 11.
BACKGROUND/PURPOSE: This study aimed to evaluate neuropsychological functioning of attention-deficit/hyperactivity disorder (ADHD) with and without comorbidities of oppositional defiant disorder (ODD) and/or conduct disorder (CD) and the mediation effects of the neuropsychological functions in the relationship between ADHD and ODD/CD symptoms to increase our understanding about these frequently co-occurring disorders.
Adolescents aged 11-18 years were interviewed by the Kiddie epidemiologic version of the Schedule for Affective Disorders and Schizophrenia to confirm their previous and current ADHD status and other psychiatric diagnoses. The performance of the Cambridge Neuropsychological Testing Automated Battery was compared among four groups: (1) ADHD with CD (ADHD+CD), regardless of ODD; (2) ADHD with ODD (ADHD+ODD) without CD; (3) ADHD without ODD/CD (ADHD-only); and (4) typically developing controls. Mediation effects of neuropsychological functioning were tested.
All three ADHD groups had impaired spatial working memory and short-term memory. Deficits in verbal memory and response inhibition were found in ADHD+ODD, but not in ADHD-only. ADHD+CD did not differ from typically developing controls in verbal working memory, signal detectability, and response inhibition. Spatial working memory partially mediated the association between ADHD and CD symptoms and alerting/signal detectability of arousal partially mediated the association between ADHD and ODD symptoms.
There were both common and distinct neuropsychological deficits between adolescents with ADHD who developed ODD only and who developed CD. ADHD comorbid with CD may be a different disease entity and needs different treatment strategies in addition to treating ADHD, while ADHD+ODD may be a severe form of ADHD and warrants intensive treatment for ADHD symptoms.
背景/目的：本研究旨在评估伴有或不伴有对立违抗性障碍（ODD）和/或品行障碍（CD）共病的注意缺陷多动障碍（ADHD）的神经认知功能，并探讨神经认知功能在 ADHD 与 ODD/CD 症状之间关系中的中介作用，以增进我们对这些常见共病障碍的理解。
通过儿童流行病学定式访谈对 11-18 岁青少年进行访谈，以确认其之前和当前的 ADHD 状态以及其他精神科诊断。比较了四个组之间的剑桥神经认知测试自动化电池的表现：（1）伴 CD 的 ADHD（ADHD+CD），无论是否有 ODD；（2）伴 ODD 的 ADHD（ADHD+ODD），无 CD；（3）无 ODD/CD 的 ADHD（ADHD 仅）；（4）典型发展对照组。测试了神经认知功能的中介作用。
所有三个 ADHD 组的空间工作记忆和短期记忆都受损。ADHD+ODD 存在言语记忆和反应抑制缺陷，但 ADHD 仅组没有。ADHD+CD 在言语工作记忆、信号检测和反应抑制方面与典型发展对照组无差异。空间工作记忆部分中介了 ADHD 与 CD 症状之间的关联，而警觉/信号检测的唤醒部分中介了 ADHD 与 ODD 症状之间的关联。
仅发展为 ODD 的和发展为 CD 的 ADHD 青少年之间存在共同和独特的神经认知缺陷。伴 CD 的 ADHD 可能是一种不同的疾病实体，除了治疗 ADHD 之外，还需要不同的治疗策略，而 ADHD+ODD 可能是 ADHD 的严重形式，需要对 ADHD 症状进行强化治疗。
