注意缺陷多动障碍（ADHD）的情感-认知-行为异质性：情绪调节障碍作为区分“单纯型ADHD”和“复合型ADHD”综合征的哨兵症状？
Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating "ADHD-simplex" and "ADHD-complex" syndromes?
作者信息
Yue Xinxin, Liu Lu, Chen Wai, Preece David A, Liu Qianrong, Li Haimei, Wang Yufeng, Qian Qiujin
机构信息
Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China.
Mental Health Service, Fiona Stanley Hospital, Perth, Australia; Graduate School of Education, University of Western Australia, Australia; School of Medicine, University of Notre Dame Australia, Fremantle, Australia; School of Psychology, Murdoch University, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia; The enAble Institute, Curtin University, Perth, Australia.
出版信息
J Affect Disord. 2022 Jun 15;307:133-141. doi: 10.1016/j.jad.2022.03.065. Epub 2022 Apr 1.
BACKGROUND
Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative "ADHD+ED" subphenotypes.
METHOD
4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments.
RESULTS
Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes.
LIMITATIONS
The data for our LCA were cross-sectional and based primarily on parent ratings.
CONCLUSION
Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential "ADHD-complex" syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.
背景
目前《精神疾病诊断与统计手册》（DSM）和《国际疾病分类》（ICD）对注意力缺陷多动障碍（ADHD）的分类在诊断标准中排除了情绪调节障碍（ED），尽管ED症状在ADHD中经常同时出现，并且可能共享共同的神经生物学基础。在本研究中，我们研究了考虑ED症状是否可以划分出更具信息性的“ADHD+ED”亚表型。
方法
招募了4106名患有ADHD的儿童。使用潜在类别分析（LCA）对ED、注意力不集中（IA）和多动/冲动（HI）症状进行分析。对得出的潜在类别（LC）亚表型进行评估，并根据共病模式、执行功能和功能损害进行验证。
结果
确定了五种伴有ED症状的LC亚表型：IA/HI+ED型（LC1）；HI+ED型（LC2）；IA+ED型（LC3）；IA/HI型（LC4）；以及IA型（LC5）。使用支持向量机分析对LCA模型进行交叉验证，确认准确率为83%。ED阳性（ED+ve）亚表型与对立违抗障碍、情绪障碍、焦虑障碍的发生率较高相关联，同时伴有更严重的孤独症特征和认知迟缓症状。在ED+ve亚表型中发现生态学执行功能损害（BRIEF评分）的发生率更高（尽管基于实验室的测量未检测到差异）。ED+ve亚表型的参与者功能损害也更严重。
局限性
我们LCA的数据是横断面的，主要基于家长评分。
结论
我们的分类模型已将IA、HI和ED症状划分为新的信息丰富的亚表型。这些分类提供了初步证据，表明ED症状可作为识别潜在“ADHD复合”综合征的哨兵特征，该综合征界定了一种更普遍、更严重、更复杂且损害更大的状况。
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