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注意缺陷多动障碍儿童的触觉敏感性改变。

Altered tactile sensitivity in children with attention-deficit hyperactivity disorder.

作者信息

Puts Nicolaas A J, Harris Ashley D, Mikkelsen Mark, Tommerdahl Mark, Edden Richard A E, Mostofsky Stewart H

机构信息

Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland;

F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland.

出版信息

J Neurophysiol. 2017 Nov 1;118(5):2568-2578. doi: 10.1152/jn.00087.2017. Epub 2017 Aug 2.

Abstract

Attention-deficit hyperactivity disorder (ADHD) is characterized by an inability to concentrate, heightened activity, and hypermotoric behavior, but sensory (e.g., tactile) problems are common. The literature on tactile impairments in ADHD is limited, with most work employing clinical observations or questionnaires. We studied tactile processing in children with ADHD and hypothesized that children with ADHD would show reduced performance in tasks closely linked to inhibition. Sixty-seven children with ADHD and 62 typically developing children (TDC) performed a battery of tasks grouped in domains: simple and choice reaction time; static and dynamic detection threshold (probing feedforward inhibition); amplitude discrimination without adaptation and with dual and single-site adaptation (probing lateral inhibition and adaptation); sequential and simultaneous frequency discrimination (previously linked to GABA); and temporal order judgment with and without a synchronous carrier stimulus. Children with ADHD could discriminate different amplitudes without adaptation, suggesting lateral inhibition is intact, but were negatively affected in all adaptation conditions, whereas TDC were only affected during single-site adaptation. Children with ADHD also showed normal frequency discrimination. Children with ADHD showed slower reaction times and higher detection threshold, likely driven by IQ and inattention, because reaction time and detection thresholds correlated with IQ and subtle motor signs. Children with ADHD showed a pattern of altered tactile processing on specific tasks, suggesting that higher cognitive function and cortical mechanisms related to adaptation are affected in ADHD, but no clear conclusion can be drawn toward impaired inhibition. This manuscript presents the first tactile psychophysical study testing different aspects of tactile processing in attention-deficit hyperactivity disorder (ADHD), using large cohort sizes of 67 children with ADHD and 65 Typically Developing Children. This study demonstrates impaired tactile processing in children with ADHD, on some, but not all tasks (showing this is not just due to attention), related to impaired cortical mechanisms. Furthermore, both IQ and soft motor skill abnormalities (common in ADHD) are correlated with tactile abnormalities.

摘要

注意力缺陷多动障碍(ADHD)的特征是无法集中注意力、活动增强和多动行为,但感觉(如触觉)问题也很常见。关于ADHD触觉障碍的文献有限,大多数研究采用临床观察或问卷调查。我们研究了ADHD儿童的触觉处理能力,并假设ADHD儿童在与抑制密切相关的任务中表现会下降。67名ADHD儿童和62名发育正常的儿童(TDC)进行了一系列任务,这些任务分为以下领域:简单反应时间和选择反应时间;静态和动态检测阈值(探测前馈抑制);无适应以及双位点和单位点适应的幅度辨别(探测侧向抑制和适应);顺序和同时频率辨别(以前与GABA有关);以及有无同步载波刺激的时间顺序判断。ADHD儿童在无适应情况下能够辨别不同幅度,表明侧向抑制功能完好,但在所有适应条件下均受到负面影响,而TDC仅在单位点适应期间受到影响。ADHD儿童的频率辨别能力也正常。ADHD儿童的反应时间较慢,检测阈值较高,这可能是由智商和注意力不集中导致的,因为反应时间和检测阈值与智商及细微运动体征相关。ADHD儿童在特定任务上表现出触觉处理改变的模式,这表明ADHD中与适应相关的高级认知功能和皮质机制受到影响,但关于抑制受损尚无明确结论。本论文首次进行了触觉心理物理学研究,测试了注意力缺陷多动障碍(ADHD)中触觉处理的不同方面,研究对象为67名ADHD儿童和65名发育正常儿童的大样本队列。这项研究表明,ADHD儿童在部分但并非所有任务中存在触觉处理受损的情况(表明这不仅仅是由于注意力问题),这与皮质机制受损有关。此外,智商和软运动技能异常(ADHD中常见)均与触觉异常相关。

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