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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参考文献(27)

[1]	YOUNG S, MOSS D, SEDGWICK O, et al. A Meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations[J]. Psychol Med, 2015, 45(2): 247-258. doi: 10.1017/S0033291714000762
[2]	FRANKE B, MICHELINI G, ASHERSON P, et al. Live fast, die young?A review on the developmental trajectories of ADHD across the lifespan[J]. Eur Neuropsychopharmacol, 2018, 28(10): 1059-1088. doi: 10.1016/j.euroneuro.2018.08.001
[3]	WALDMAN I D, ROWE R, BOYLAN K, et al. External validation of a bifactor model of oppositional defiant disorder[J]. Mol Psychiatry, 2021, 26(2): 682-693. doi: 10.1038/s41380-018-0294-z
[4]	NOORDERMEER S, LUMAN M, WEEDA W D, et al. Risk factors for comorbid oppositional defiant disorder in attention-deficit/hyperactivity disorder[J]. Eur Child Adolesc Psychiatry, 2017, 26(10): 1155-1164. doi: 10.1007/s00787-017-0972-4
[5]	ESKANDER N. The psychosocial outcome of conduct and oppositional defiant disorder in children with attention deficit hyperactivity disorder[J]. Cureus, 2020, 12(8): e9521.
[6]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5[M]. Washington, DC: American Psychiatric Publishing, 2013.
[7]	周晋波, 郭兰婷, 陈颖. 中文版注意缺陷多动障碍SNAP-Ⅳ评定量表-父母版的信效度[J]. 中国心理卫生杂志, 2013, 27(6): 424-428. doi: 10.3969/j.issn.1000-6729.2013.06.005 ZHOU J B, GUO L T, CHEN Y. Reliability and validity of the Chinese Version of Attention Deficit Hyperactivity Disorder SNAP-Ⅳ Scale-Parent Version[J]. Chin Ment Health J, 2013, 27(6): 424-428. (in Chinese) doi: 10.3969/j.issn.1000-6729.2013.06.005
[8]	THOMPSON T, LLOYD A, JOSEPH A, et al. The Weiss Functional Impairment Rating Scale-Parent Form for assessing ADHD: evaluating diagnostic accuracy and determining optimal thresholds using ROC analysis[J]. Q Life Res, 2017, 26(7): 1879-1885. doi: 10.1007/s11136-017-1514-8
[9]	钱英, 杜巧新, 曲姗, 等. Weiss功能缺陷量表父母版的信效度[J]. 中国心理卫生杂志, 2011, 25(10): 767-771. doi: 10.3969/j.issn.1000-6729.2011.10.012 QIAN Y, DU Q X, QU S, et al. Reliability and validity of the Parental Version of Weiss Functional Disability Scale[J]. Chin Ment Health J, 2011, 25(10): 767-771. (in Chinese) doi: 10.3969/j.issn.1000-6729.2011.10.012
[10]	ZHENG Y, DU Y, SU L Y, et al. Reliability and validity of the Chinese Version of Questionnaire-Children with Difficulties for Chinese children or adolescents with attention-deficit/hyperactivity disorder: a cross-sectional survey[J]. Neuropsychiatr Dis Treat, 2018, 14: 2181-2190. doi: 10.2147/NDT.S166397
[11]	杜亚松. 促进注意缺陷多动障碍患儿社会功能的改善[J]. 中国儿童保健杂志, 2010, 18(4): 265-266. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201004003.htm DU Y S. Promoting the improvement of social functioning in children with attention deficit hyperactivity disorder[J]. Chin J Child Health Care, 2010, 18(4): 265-266. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201004003.htm
[12]	杨莉. 注意缺陷多动障碍2017-2019年研究现状与展望[J]. 中国心理卫生杂志, 2020, 34(7): 594-601. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202007010.htm YANG L. Attention deficit hyperactivity disorder research status and outlook 2017-2019[J]. Chin Ment Health J, 2020, 34(7): 594-601. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202007010.htm
[13]	KOK F M, GROEN Y, FUERMAIER A B, et al. Problematic peer functioning in girls with ADHD: a systematic literature review[J]. PLoS One, 2016, 11(11): e0165119. doi: 10.1371/journal.pone.0165119
[14]	FARAONE S V, ASHERSON P, BANASCHEWSKI T, et al. Attention-deficit/hyperactivity disorder[J]. Nat Rev Dis Prim, 2015, 1: 15020. doi: 10.1038/nrdp.2015.20
[15]	GREENE R W, BIEDERMAN J, FARAONE S V, et al. Toward a new psychometric definition of social disability in children with attention-deficit hyperactivity disorder[J]. J Am Acad Child Adolesc Psychiatry, 1996, 35(5): 571-578. doi: 10.1097/00004583-199605000-00011
[16]	STEIN M A, SZUMOWSKI E, BLONDIS T A, et al. Is ADHD social disability really comorbidity?[J]. J Am Acad Child Adolesc Psychiatry, 1996, 35(12): 1570-1571.
[17]	陈强, 李静, 袁滨, 等. 是否共患阿斯伯格综合征的注意缺陷多动障碍儿童社会功能特征[J]. 中国学校卫生, 2019, 40(8): 1258-1260. doi: 10.16835/j.cnki.1000-9817.2019.08.039 CHEN Q, LI J, YUAN B, et al. Characteristics of social functioning in children with attention deficit hyperactivity disorder with or without co-occurring asperger's syndrome[J]. Chin J Sch Health, 2019, 40(8): 1258-1260. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2019.08.039
[18]	刘璐, 高倩, 李海梅, 等. 共患对立违抗障碍影响NET1基因与注意缺陷多动障碍的关联[J]. 中华医学杂志, 2015, 95(41): 3351-3356. doi: 10.3760/cma.j.issn.0376-2491.2015.41.008 LIU L, GAO Q, LI H M, et al. Influence of ODD diagnosis on the association between NET1 and attention-deficit/hyperactivity disorder[J]. Natl Med J China, 2015, 95(41): 3351-3356. (in Chinese) doi: 10.3760/cma.j.issn.0376-2491.2015.41.008
[19]	高兵玲, 吴赵敏, 江家靖, 等. 注意缺陷多动障碍共患对立违抗障碍儿童的家庭环境因素[J]. 中国心理卫生杂志, 2019, 33(6): 425-430. doi: 10.3969/j.issn.1000-6729.2019.06.006 GAO B L, WU Z M, JIANG J J, et al. Family environment factors in children with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder[J]. Chin Ment Health J, 2019, 33(6): 425-430. (in Chinese) doi: 10.3969/j.issn.1000-6729.2019.06.006
[20]	熊伟, 张恩, 杨永春, 等. 家庭环境对伴对立违抗的注意缺陷多动障碍患儿的影响[J]. 临床精神医学杂志, 2020, 30(5): 349-351. doi: 10.3969/j.issn.1005-3220.2020.05.018 XIONG W, ZHANG E, YANG Y C, et al. Influences of family environment on children with attention deficit hyperactivity disorder comorbid oppositional defiant disorder[J]. J Clin Psychiatry, 2020, 30(5): 349-351. (in Chinese) doi: 10.3969/j.issn.1005-3220.2020.05.018
[21]	SCOTT S, BRISKMAN J, O'CONNOR T G, et al. Early prevention of antisocial personality: long-term follow-up of two randomized controlled trials comparing indicated and selective approaches[J]. Am J Psychiatry, 2014, 171(6): 649-657. doi: 10.1176/appi.ajp.2014.13050697
[22]	潘景雪, 张劲松, 帅澜, 等. 学龄前儿童注意缺陷多动障碍共患对立违抗障碍执行功能的研究[J]. 中华精神科杂志, 2018, 51(3): 182-187. doi: 10.3760/cma.j.issn.1006-7884.2018.03.005 PAN J X, ZHANG J S, SHUAI L, et al. A study of executive functioning in preschool children with co-occurring oppositional defiant disorder in attention deficit hyperactivity disorder[J]. Chin J Psychiatry, 2018, 51(3): 182-187. (in Chinese) doi: 10.3760/cma.j.issn.1006-7884.2018.03.005
[23]	苏程, 刘军, 汤姿英, 等. 家庭沙盘游戏治疗注意缺陷多动障碍共患对立违抗障碍儿童长期疗效研究[J]. 中国实用儿科杂志, 2013, 28(12): 938-939, 942. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK201312020.htm SU C, LIU J, TANG Z Y, et al. Long-term effect of family sandplay on children with attention deficit hyperactivity disorder and oppositional defiant disorder[J]. Chin J Pract Pediatr, 2013, 28(12): 938-939, 942. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK201312020.htm
[24]	MORDRE M, GROHOLT B, KJELSBERG E, et al. The impact of ADHD and conduct disorder in childhood on adult delinquency: a 30 years follow-up study using official crime records[J]. BMC Psychiatry, 2011, 11: 57. doi: 10.1186/1471-244X-11-57
[25]	GADOW K D, NOLAN E E. Differences between preschool children with ODD, ADHD, and ODD+ADHD symptoms[J]. J Child Psychol Psychiatry, 2002, 43(2): 191-201. doi: 10.1111/1469-7610.00012
[26]	JIANG X, LIU L, JI H, et al. Association of affected neurocircuitry with deficit of response inhibition and delayed gratification in attention deficit hyperactivity disorder: a narrative review[J]. Front Hum Neuros, 2018, 12: 506.
[27]	JIANG W, LI Y, DU Y, et al. Emotional regulation and executive function deficits in unmedicated Chinese children with oppositional defiant disorder[J]. Psychiatry Invest, 2016, 13(3): 277-287.