Objective To examine the efficacy and safety of methylphenidate on children with different subtypes of attention deficit hy-peractivity disorder( ADHD) ,and further explore potential factors which may contribute to the prognosis of ADHD. Methods The diagnostic assessment of ADHD was performed according to the recommendations of the diagnosis and treatment of ADHD for Chinese children. Efficacy of medication on ADHD was evaluated by means of ADHD parent rating scale scores, Conners' parent rating scale, and continuous performance test(CPT). ADHD children were given methylphenidate dose titration systematically and followed up for 6 months. Factors were collected including symptom severity, intelligence quotient, learning achievement, which may contribute to the prognosis of ADHD. Results 1. The differences between before and after treatment were statistically significant, including the results of ADHD parent rating scale scores, Conners' parent rating scale, and CPT. 2. Comparison of efficacy in different subtypes; (1) Reduction rate of ADHD parent rating scale scores:The differences between combined type (ADHD - CT) and predominantly inattentive type ( ADHD - PI) had no statistical significance; compared with ADHD - CT or ADHD - PI, hyperactive - impulsive type (ADHD - HI) had lower reduction rate; (2 ) Reduction rate of Conners' parent rating scale;the differences between ADHD - CT, ADHD - PI or ADHD - HI had no statistical significance; (3) Reduction rate of CPT:the differences between ADHD - CT, ADHD - PI or ADHD - HI had no statistical significance; (4) Effective rate and effectual rate:effectual rate of ADHD - CT was 68. 25% , while effectual rate of ADHD - CT was 55. 56% ; effectual rate of ADHD - PI was 75. 82% , while effectual rate of ADHD - PI was 56.04% ; effectual rate of ADHD - HI was 63. 64% , while effectual rate of ADHD - HI was 45.45%. 3. Factors influencing the efficacy: the severity of symptoms and intelligence quotient were related to the medication efficacy. Conclusions Methylphenidate treatment on ADHD children is safe and effective; Methylphenidate treatment on ADHD - CT and ADHD - PI is more effective than on ADHD - HI. Factors influencing the efficacy include the severity of symptoms and intelligence quotient.%目的 观察哌甲酯对不同亚型注意缺陷多动障碍(ADHD)患儿的疗效和安全性,寻找潜在的疗效影响因素及疗效预测指标.方法 入组标准为符合我国《儿童注意缺陷多动障碍诊疗建议》中ADHD诊断标准的患儿,给予系统的哌甲酯剂量滴定.以父母填写的ADHD评定量表、Conners'量表和对儿童进行的持续性操作测试(CPT)作为疗效评价指标,随访观察6个月.收集潜在的疗效影响因素资料,包括就诊时症状严重程度、智商、学习成绩等.结果 1.总的疗效指标分析:父母填写的ADHD症状评定量表分、Conners'量表分、儿童进行的CPT治疗前后差值均具有统计学意义.2.各亚型疗效比较:(1) ADHD症状评定量表总分的减分率:混合型与注意障碍为主型比较差异无统计学意义；多动冲动型及混合型比较差异有统计学意义；多动冲动型与注意障碍为主型比较差异有统计学意义；(2) Conners'量表减分率:混合型、注意障碍为主型、多动冲动型比较差异无统计学意义；(3) CPT平均分的减分率:混合型、注意障碍为主型、多动冲动型比较差异无统计学意义；(4)有效率和显效率:混合型有效率68.25％,显效率55.56％；注意障碍为主型有效率75.82％,显效率56.04％；多动冲动型有效率63.64％,显效率45.45％.3.疗效影响因素:就诊时症状的严重程度和韦氏智商评分与疗效相关.结论 哌甲酯治疗儿童ADHD安全有效,对混合型和注意障碍为主型的ADHD患儿的疗效可能优于多动冲动型.疗效的可能影响因素包括治疗前症状的严重程度和韦氏智商评分等.
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