注意缺陷多动障碍共患抽动障碍儿童的执行功能

摘要

Objective:To explore whether executive function (EF) deficits are specific to attention-deficit/hyperactivity disorder (ADHD) or whether such deficits are also associated with tics disorder (TD).Methods:A total of 112 ADHD comorbid TD (ADHD +TD) children,112 pure ADHD children and 112 normal controls were selected.The diagnosis was according to the criteria of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-Ⅳ).The groups were matched by sex,age (less than 6 months) and IQ.The Rey-Osterrieth complex Figure Test,the Trail Making Test,and Stroop Color Word Test were administered to assess working memory,shifting and inhibitory function respectively.The results of the comparison between groups used multivariate analysis of variance,and the statistically significant indicators were conducted with apost-test comparison.Results:Both pure ADHD group and ADHD + TD group performed worse (P ＜ 0.05) in the aspects of the delay recalling structure score,the immediate memory detail score,delay recalling detail score of Rey complex figure test,time of numberletter part and shifting time of trail making test,the time of Stroops2,4,the errors of Stroop 4 and word interference than normal controls.In the aspects of the score of the structure and detail forgetting,the pure ADHD group performed worse (P ＜0.05) than normal controls,but the ADHD + TD group didn't.The differences were significant (P ＜ 0.05).The other differences all weren't significant (P ＞ 0.05).Conclusion:It suggests that children with ADHD have executive function deficit,particular in the tests assessing working memory,shifting and inhibitory function,whether or not comorbid tics disorder.Comorbid tics disorders may not be the factor of aggravation.%目的:探讨注意缺陷多动障碍(ADHD)共患抽动障碍儿童的执行功能特点.方法:以性别、年龄、智商匹配的,符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的ADHD共患抽动障碍(ADHD+ TD)、单纯ADHD及正常对照儿童各112例为研究对象,采用Rey复杂图形测试和连线测试及Stroop色词命名分别对其执行功能的工作记忆能力、定势转换能力、反应抑制能力进行评估.评估结果的组间比较采用多元方差分析,并对有统计学意义的指标进行事后检验两两比较.结果:两病例组的Rey复杂图形测试的延迟回忆结构分、即时细节分、延迟记忆细节分、Stroop4试错误数得分低于对照组,而数字字母连线时间,转换时间,Stroop2、4试耗时,字义干扰时的耗时均高于对照组(均P＜0.05).在结构遗忘及细节遗忘方面,单纯ADHD组的得分均低于对照组,而ADHD共患TD组的得分与对照组相比差异无统计学意义;ADHD共患TD组及单纯ADHD组在所有任务指标上的差异均无统计学意义(均P＞0.05).结论:ADHD儿童在工作记忆、定势转换、反应抑制的执行功能层面上均存在明显的缺陷,共患抽动障碍可能并不会加重ADHD儿童的这些执行功能缺陷.