共患对立违抗障碍的注意缺陷多动障碍儿童社会功能特征

陈强; 李德欣; 李静; 齐洋洋; 刘慧; 陈淑梅; 廖远航; 钟洁琼; 李秀红

doi:10.16835/j.cnki.1000-9817.2023.02.007

共患对立违抗障碍的注意缺陷多动障碍儿童社会功能特征

doi: 10.16835/j.cnki.1000-9817.2023.02.007

1.
广东省珠海市妇幼保健院儿童心理卫生科, 519001
2.
珠海市香洲区实验学校
3.
珠海市香洲区五洲幼儿园
4.
中山大学公共卫生学院妇幼卫生系

基金项目:

广东省医学科学技术基金项目 A2020479

详细信息

作者简介:
陈强(1980-), 男, 四川安岳人, 硕士, 副主任医师, 主要从事儿童发育行为障碍的诊疗工作

通讯作者:
李秀红, E-mail: lixh@mail.sysu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R748 R179
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- 被引次数: 0
出版历程
- 收稿日期: 2022-06-02
- 修回日期: 2022-08-27
- 网络出版日期: 2023-03-02
- 刊出日期: 2023-02-25

Social functioning characteristics of children with co-occurrence of attention deficit hyperactivity disorder and oppositional defiant disorder

1.
Department of Children Psychological Health, Zhuhai Maternal and Child Health Care Hospital, Zhuhai(519001), Guangdong Province, China

摘要

摘要: 目的探索共患对立违抗障碍(ODD)的注意缺陷多动障碍(ADHD)儿童社会功能特征，为改善ADHD儿童社会功能提供参考。方法采用中文版注意缺陷多动障碍评定量表-父母版(SNAP-Ⅳ)、Weiss功能缺陷量表父母版(WFIRS-P)及儿童困难问卷(QCD)，对首次就诊于珠海市妇幼保健院儿童心理卫生科的192名单纯ADHD儿童、243名共患ODD的ADHD儿童，以及珠海市某学校118名正常对照儿童进行评估分析。结果 3组儿童SNAP-Ⅳ量表注意缺陷因子得分分别为[1.9(1.7，2.1)，1.8(1.6，1.9)，1.0(0.6，1.2)]，多动冲动因子得分分别为[1.8(1.4，2.1)，1.6(1.1，1.8)，0.7(0.2，1.0)]，对立违抗因子得分分别为[1.6(1.5，1.9)，1.0(0.8，1.1)，0.8(0.5，1.0)]，组间差异均有统计学意义(H值分别为268.44，237.97，418.66，P值均 < 0.01)。3组儿童WFIRS-P量表各维度及总分分别为家庭[0.8(0.6，1.1)，0.6(0.3，0.8)，0.3(0.1，0.6)]；学习和学校[0.8(0.5，1.1)，0.8(0.5，1.0)，0.3(0.1，0.5)]；生活技能[1.0(0.7，1.2)，0.8(0.6，1.0)，0.6(0.4，0.8)]；自我管理[1.0(0.3，1.0)，0.7(0.3，1.0)，0.3(0.0，0.7)]；社会活动[0.7(0.4，1.0)，0.6(0.3，0.9)，0.3(0.0，0.4)]；冒险活动[0.3(0.2，0.5)，0.2(0.1，0.4)，0.1(0.0，0.2)]；总分[0.8(0.6，1.0)，0.6(0.5，0.8)，0.4(0.2，0.6)]，组间差异均有统计学意义(H值分别为108.82，122.45，60.17，40.58，96.17，76.57，138.30，P值均 < 0.01)。3组儿童QCD量表得分分别为[30.0(24.0，37.0)，32.0(27.0，40.0)，47.0(37.0，52.3)]，组间差异有统计学意义(H=124.65，P < 0.01)。多元线性回归分析结果表明，注意缺陷和对立违抗症状均是患儿WFIRS-P总分及QCD分的影响因素(R²值分别为0.40，0.25，P值均 < 0.05)。结论共患ODD的ADHD儿童在社会功能各个维度上的缺陷较ADHD儿童更为严重，社会功能缺陷受注意缺陷和对立违抗症状的影响。
- 注意力缺陷障碍伴多动 /
- 精神卫生 /
- 回归分析 /
- 儿童
Abstract: Objective To explore the social functioning characteristics of children with co-ocurrence of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) for intervention reference. Methods The Chinese Version of Swanson Nolan and Pelham, Version Ⅳ Scale-Parent Form(SNAP-Ⅳ), the Chinese Version of Weiss Functional Impairment Scale-Parent(WFIRS-P), and the Questionnaire-Children with Difficulties (QCD) were applied to 192 children with ADHD, 243 children with co-occurrence of ADHD and ODD, who firstly visited the Department of Children Psychological Health of Zhuhai Maternal and Child Health Care Hospital, and 118 healthy control children from a school in Zhuhai. Results The scores of attention deficit factor in SNAP-Ⅳ scale of children in three groups were[1.9(1.7, 2.1), 1.8(1.6, 1.9), 1.0(0.6, 1.2)], the scores of hyperactive impulsivity were[1.8(1.4, 2.1), 1.6(1.1, 1.8), 0.7(0.2, 1.0)] the scores of oppositional defiant were[1.6(1.5, 1.9), 1.0(0.8, 1.1), 0.8(0.5, 1.0)], the differences were statistically significant(H=268.44, 237.97, 418.66, P < 0.01). The dimensions and total scores of the three groups of children's WFIRS-P scale were family[0.8(0.6, 1.1), 0.6(0.3, 0.8), 0.3(0.1, 0.6)]; learning and school[0.8(0.5, 1.1), 0.8(0.5, 1.0), 0.3(0.1, 0.5)]; life skills[1.0(0.7, 1.2), 0.8(0.6, 1.0), 0.6(0.4, 0.8)]; self-management [1.0(0.3, 1.0), 0.7(0.3, 1.0), 0.3(0.0, 0.7)]; social activities [0.7(0.4, 1.0), 0.6(0.3, 0.9), 0.3(0.0, 0.4)]; adventure activities[0.3(0.2, 0.5), 0.2(0.1, 0.4), 0.1(0.0, 0.2)]; the total score[0.8(0.6, 1.0), 0.6(0.5, 0.8), 0.4(0.2, 0.6)], the difference between the groups was statistically significant(H=108.82, 122.45, 60.17, 40.58, 96.17, 76.57, 138.30, P < 0.01). The difference between the QCD scale scores of children in the three groups was statistically significant[30.0(24.0, 37.0), 32.0(27.0, 40.0), 47.0(37.0, 52.3), H=124.65, P < 0.01). Multiple regression analysis showed that attention deficit, and oppositional defiant symptoms were associated with both the total WFIRS-P score and the QCD score of children(R²=0.40, 0.25, P < 0.05). Conclusion Children with co-occurrence of ADHD and ODD have more severe deficits in all dimensions of social functioning than children with ADHD, which might be associated with attention deficit and oppositional defiant symptoms.
- Attention deficit disorder with hyperactivity /
- Mental health /
- Regression analysis /
- Child
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 3组儿童SNAP-Ⅳ各因子得分比较[M(P₂₅, P₇₅)]

Table 1. Comparison of the scores of each factor of SNAP-Ⅳ in the three groups[M(P₂₅, P₇₅)]

组别	人数	注意缺陷	多动冲动	对立违抗
ADHD+ODD组	243	1.9(1.7，2.1)	1.8(1.4，2.1)	1.6(1.5，1.9)
ADHD组	192	1.8(1.6，1.9)	1.6(1.1，1.8)	1.0(0.8，1.1)
对照组	118	1.0(0.6，1.2)	0.7(0.2，1.0)	0.8(0.5，1.0)
H值		268.44	237.97	418.66
P值		< 0.01	< 0.01	< 0.01

下载: 导出CSV

表 2 3组儿童WFIRS-P及QCD得分比较[M(P₂₅, P₇₅)]

Table 2. Comparison of the scores of WFIRS-P and QCD in the three groups[M(P₂₅, P₇₅)]

组别	人数	家庭	学习和学校	生活技能	自我管理	社会活动	冒险活动	WFIRS-P总分	QCD
ADHD+ODD组	243	0.80(0.6，1.1)	0.80(0.5，1.1)	1.00(0.7，1.2)	1.00(0.3，1.0)	0.71(0.4，1.0)	0.30(0.2，0.5)	0.76(0.6，1.0)	30.00(24.0，37.0)
ADHD组	192	0.56(0.3，0.8)	0.75(0.5，1.0)	0.80(0.6，1.0)	0.67(0.3，1.0)	0.57(0.3，0.9)	0.20(0.1，0.4)	0.60(0.5，0.8)	32.00(27.0，40.0)
对照组	118	0.30(0.1，0.6)	0.30(0.1，0.5)	0.63(0.4，0.8)	0.33(0.0，0.7)	0.29(0.0，0.4)	0.10(0.0，0.2)	0.35(0.2，0.6)	47.00(37.0，52.3)
H值		108.82	122.45	60.17	40.58	96.17	76.57	138.30	124.65
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

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表 3 儿童社会功能与SNAP-Ⅳ各因子多元线性回归分析(n=553)

Table 3. Multiple regression analysis of children's social function and each factor of SNAP-Ⅳ(n=553)

因变量	常数与自变量	β值	标准误	B值	t值	P值	R²值	调整R²值
WFIRS-P总分	常数	0.06	0.03	-	1.79	0.07	0.40	0.40
	注意缺陷	0.19	0.02	0.36	7.95	< 0.01
	多动冲动	0.03	0.02	0.07	1.57	0.12
	对立违抗	0.17	0.02	0.31	7.20	< 0.01
QCD分	常数	51.15	1.32	-	38.80	< 0.01	0.25	0.25
	注意缺陷	-7.98	0.99	-0.40	-8.05	< 0.01
	多动冲动	-0.37	0.88	-0.02	-0.42	0.67
	对立违抗	-2.76	0.97	-0.13	-2.84	0.01

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