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注意缺陷多动障碍合并高功能孤独症患儿的执行功能特点

[Characteristics of executive function in children with attention deficit/hyperactivity disorder comorbid with high functioning autism].

作者信息

Zhang S H, Wang P, Yang B R, Zhong Y Y, Wang Y F

机构信息

Department of Child healthcare, Shenzhen Children's Hospital, Shenzhen 518038, China.

Department of Child Psychiatry, Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2020 Aug 18;100(31):2446-2451. doi: 10.3760/cma.j.cn112137-20191216-02750.

Abstract

To explore the characteristics of executive function in children with attention-deficit/hyperactivity disorder comorbid with high functioning autism. A total of 165 children with attention-deficit/hyperactivity disorder (ADHD group), 65 children with attention-deficit/Hyperactivity disorder comorbid with high functioning autism (ADHD-HFA group), and 84 healthy controls (control group) (based on the criteria of DSM-5) were recruited from the Outpatient Clinic of Child Healthcare Department of Shen Zhen Children's Hospital. The Rey complex figure test (RCFT), trail making test (TMT), Stroop color-word test were used to assess working memory, shifting and inhibition. ADHD group (2.1±1.9, 7±5, 2.1±2.0 and 7±5) and ADHD-HFA group (2.0±2.0, 7±6, 2.0±2.1 and 6±5) performed worse than control group (3.4±2.0, 10±5, 3.4±2.0 and 10±6) in Rey complex figure test (all <0.05). ADHD group ((171±8) s, (27.40±0.82) s and (52.29±1.62) s) and ADHD-HFA group ((197±11) s, (29.7±1.1) s and (58.6±2.1) s) group took longer time on the TMT-2, Stroop2 and Stroop4 test than control group ((135±18) s, (22.4±1.9) s and (38.7±3.8) s) (all <0.05). In children with low intelligence quotient (IQ), ADHD group ((30±8) s) and ADHD-HFA group ((34±9) s) performed worse on Stroop3 test than control group ((20±4) s) (all <0.05). In children with average IQ, ADHD group ((19±5) s and (24±8) s) took longer time on the Stroop1 and Stroop3 test than control group ((16±3) s and (19±4) s) (all <0.05). In children with high IQ, ADHD-HFA group ((20±8) s) spent more time on Stroop1 than control group ((15±4) s) (<0.05). Inattention symptoms were associated with the time on TMT-2 of ADHD-HFA group (=0.275 and 0.329, all <0.05). The score of item 1 in autism spectrum screening questionnaire (ASSQ) was negatively correlated with immediate recall structure and detail scores as well as delay structure scores of Rey complex figure test (=-0.358, -0.326 and -0.306, all <0.05). The score of item 4 was positively correlated with errors of Stroop4 (=0.296, <0.05). The score of item 22 was positively correlated with time of color interference (=0.279, <0.05). Children with ADHD-HFA are likely to demonstrate the spatial working memory, shifting and inhibition deficits associated with ADHD alone. Some domains of executive function impairment in ADHD-HFA group are related with symptoms of inattention/hyperactivity and autism.

摘要

探讨注意缺陷多动障碍合并高功能自闭症患儿的执行功能特点。从深圳市儿童医院儿童保健科门诊招募了165名注意缺陷多动障碍患儿(ADHD组)、65名注意缺陷多动障碍合并高功能自闭症患儿(ADHD-HFA组)和84名健康对照儿童(对照组)(基于DSM-5标准)。采用雷氏复杂图形测验(RCFT)、连线测验(TMT)、Stroop色词测验评估工作记忆、转换和抑制功能。ADHD组(2.1±1.9、7±5、2.1±2.0和7±5)和ADHD-HFA组(2.0±2.0、7±6、2.0±2.1和6±5)在雷氏复杂图形测验中的表现比对照组(3.4±2.0、10±5、3.4±2.0和10±6)差(均P<0.05)。ADHD组((171±8)秒、(27.40±0.82)秒和(52.29±1.62)秒)和ADHD-HFA组((197±11)秒、(29.7±1.1)秒和(58.6±2.1)秒)在TMT-2、Stroop2和Stroop4测验上花费的时间比对照组((135±18)秒、(22.4±1.9)秒和(38.7±3.8)秒)长(均P<0.05)。在低智商儿童中,ADHD组((30±8)秒)和ADHD-HFA组((34±9)秒)在Stroop3测验中的表现比对照组((20±4)秒)差(均P<0.05)。在平均智商儿童中,ADHD组((19±5)秒和(24±8)秒)在Stroop1和Stroop3测验上花费的时间比对照组((16±3)秒和(19±4)秒)长(均P<0.05)。在高智商儿童中,ADHD-HFA组((20±8)秒)在Stroop1测验上花费的时间比对照组((15±4)秒)长(P<0.05)。注意力不集中症状与ADHD-HFA组在TMT-2上的时间相关(r=0.275和0.329,均P<0.05)。自闭症谱系筛查问卷(ASSQ)第1项得分与雷氏复杂图形测验的即时回忆结构和细节得分以及延迟结构得分呈负相关(r=-0.358、-0.326和-0.306,均P<0.05)。第4项得分与Stroop4的错误数呈正相关(r=0.296,P<0.05)。第22项得分与颜色干扰时间呈正相关(r=0.279,P<0.05)。ADHD-HFA患儿可能单独表现出与ADHD相关的空间工作记忆、转换和抑制缺陷。ADHD-HFA组执行功能损害的某些领域与注意力不集中/多动症状和自闭症有关。

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