学龄期注意缺陷多动障碍男生执行功能异质性与父母压力相关性的病例对照研究

摘要

目的 探讨注意缺陷多动障碍(ADHD)儿童的执行功能异质性与父母压力的关系.方法 本研究为病例对照研究,病例组为学龄期ADHD男生(执行功能缺陷亚组和完好亚组),对照组为正常发育学龄期男生.分别以STROOP色-词测验、威斯康辛卡片分类测验(WCST)、剑桥神经心理成套测验(CANTAB)和韦氏儿童智力量表第4版(WISC-Ⅳ)的相应指标评价执行功能,Swanson Nolan and Pelham,Version Ⅳ(SNAP-Ⅳ)量表父母版注意缺陷、多动/冲动分量表评估儿童的ADHD临床症状,SNAP-Ⅳ对立违抗得分和Conners父母症状问卷(PSQ)评估儿童的共病情况,以父母压力指数量表(PSI)评估父母压力.结果 ADHD组104例、对照组47例进入本文分析.两组年龄差异有统计学意义,两组SNAP-Ⅳ和PSQ各因子差异均有统计学意义.执行功能:执行功能缺陷亚组(51例)和完好亚组(53例)差异有统计学意义,执行功能完好亚组和对照组差异无统计学意义.ADHD组及其亚组较对照组比较,不论在儿童维度及总分、家长维度及总分、父母压力总分均显著升高,执行功能完好亚组较缺陷亚组除在注意缺陷多动因子中存在差异,在儿童维度及总分、家长维度及总分、父母压力总分差异均无统计学意义.结论 ADHD儿童会带来父母压力增加,执行功能完好也不能改善父母压力的状况.%Objective The relationship between heterogeneous executive function (EF) and parenting stress among school boys with attention deficit hyperactivity disorder(ADHD) was explored.Methods In this case-control study,boys with ADHD were chosen as case group (subgroup of Children with EF deficits and subgroup of Children with intact EF),boys with normal development were chosen as control group.We used the STROOP color-word test,Wisconsin Card Sorting Task (WCST),Cambridge Neuropsychological Test Automatic Battery (CANTAB),Wechsler Intelligence Scale for Children-Fourth Edition (WISC-Ⅳ) to evaluate the executive function,and used Swanson Nolan and Pelham,Version Ⅳ (SNAP-Ⅳ) inattention and hyperactivity/impulsivity subscales to assess the ADHD symptom,SNAP-Ⅳ oppositional defiant subscale and Parent Symptom Questionnaire (PSQ) for the comorbidity,and Parenting Stress Index (PSI) for parenting stress.Results Data from 104 drug-naive boys diagnosed with ADHD (mean age 9.95) and 47 boys showing normal development (mean age 10.79) were collected.Their age was statistically different.The differences in SNAP-Ⅳ scores,PSQ scores were all statistically significant.The EF differences between ADHD intact EF subgroup and EF deficit subgroup were all statistically significant,but there were no significant difference between intact EF subgroup and control group.Compared to control group,the PSI total scores and all the factor scores of ADHD group and both of the subgroups were significantly higher,but there were no difference between ADHD intact EF subgroup and EF deficit subgroup except for distractibility/hyperactivity factor.Conclusion Overall,increased stress was found in ADHD boys' parents regardless of the EF subgroup.Having intact EF didn't improve the stress of parenting.