注意缺陷多动障碍男童精细动作技能与执行功能的关系

宋以玲; 任园春; 范碧瑶; 杨莉; 王芳; 丰雷

doi:10.16835/j.cnki.1000-9817.2023.10.019

注意缺陷多动障碍男童精细动作技能与执行功能的关系

doi: 10.16835/j.cnki.1000-9817.2023.10.019

宋以玲^{1, 2},
任园春^1, ,,
范碧瑶¹,
杨莉³,
王芳⁴,
丰雷⁵

1.
北京师范大学体育与运动学院，北京 100875
2.
清华大学体育部
3.
北京大学精神卫生研究所
4.
北京市海淀区万泉小学体育教研组
5.
首都医科大学附属北京安定医院/国家精神心理疾病临床医学研究中心/精神疾病诊断与治疗北京市重点实验室

基金项目:

教育部人文社会科学研究项目 21YJA890025

国家重点研发计划重点专项 2017YFC1311101

北京师范大学教学建设与改革项目 2021-28

详细信息

作者简介:
宋以玲(1995-)，女，山东淄博人，在读博士，主要研究方向为运动康复与儿童动作发展

通讯作者:
任园春，E-mail: yuanchun-ren@bnu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: B844.1 R179 G804.66
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- 被引次数: 0
出版历程
- 收稿日期: 2023-04-27
- 修回日期: 2023-07-20
- 网络出版日期: 2023-10-27
- 刊出日期: 2023-10-25

The relationship between fine motor skills and executive function in boys with attention deficit hyperactivity disorder

SONG Yiling^{1, 2},
REN Yuanchun^{1
, ,},
FAN Biyao¹,
YANG Li³,
WANG Fang⁴,
FENG Lei⁵

1.
College of Physical Education and Sports, Beijing Normal University, Beijing(100875), China

摘要

摘要: 目的探讨学龄期6~10岁注意缺陷多动障碍(ADHD)男童的精细动作技能和执行功能之间的关系，为促进ADHD男童执行功能的发展提供参考。方法于2020年11月至2021年5月，从北京市某三甲医院和北京市某公立小学招募65名ADHD男童，按照年龄和性别匹配募集正常发育的65名男童为正常对照组。采用儿童动作协调能力标准评估工具(MABC-2)评估儿童精细动作技能，利用Stroop色词测验(SCWT)、Rey复杂图形测验(ROCFT)、连线测验(TMT)分别评估儿童的抑制控制、工作记忆和认知灵活性。采用独立样本t检验分析两组间的差异，利用Pearson相关分析和分层回归分析探讨ADHD男童精细动作技能和执行功能之间的关系。结果在精细动作技能测试中，ADHD男童得分(8.68±3.62)低于正常男童(11.22±2.27)(t=4.80)；在执行功能测试中，ADHD男童的SCWT、ROCFT、TMT测试结果均差于正常男童(t=-4.53~4.42)(P值均＜0.05)。相关性分析显示，ADHD男童的精细动作技能得分与字义错误数(r=-0.35)、颜色错误数(r=-0.42)呈负相关，与延时结构(r=0.30)和细节(r=0.25)记忆得分呈正相关，与TMT-A反应时(r=-0.34)、TMT-B反应时(r=-0.26)、错误数(r=-0.43)呈负相关(P值均＜0.05)。分层回归分析显示，ADHD男童的精细动作技能得分对抑制控制、工作记忆和认知灵活性的测试结果均有预测作用(P值均＜0.05)，解释率分别为15%，7%，19%。结论 ADHD男童的精细动作技能与执行功能有相关性，且精细动作技能可在一定程度上预测抑制控制、工作记忆和认知灵活性。可通过发展ADHD男童的精细动作技能来促进其执行功能的发展。
- 注意力缺陷障碍伴多动 /
- 精神卫生 /
- 执行功能 /
- 儿童 /
- 男(雄)性
Abstract: Objective To investigate the relationship between fine motor skills and executive function in school-aged boys with attention deficit hyperactivity disorder (ADHD) aged 6-10 years, so as to provide a reference for promoting executive function. Methods From November 2022 to May 2021, 65 boys with ADHD were recruited from a tertiary hospital in Beijing and a public elementary school in Beijing, and 65 boys with typical development according to age and sex were recruited as controls. Children's fine motor skills were assessed using the movement assessment battery for children, second version (MABC-2), and children's inhibitory control, working memory, and cognitive flexibility were assessed using the Stroop color word test (SCWT), Rey osterrich complex figure test (ROCFT) and trail making test (TMT), respectively. Independent samples t-tests were used to analyze the differences between the two groups, and Pearson correlation analysis and stratified regression analysis were used to explore the relationship between fine motor skills and executive functioning in boys with ADHD. Results In the fine motor skills test, boys with ADHD scored significantly lower (8.68±3.62) than control boys (11.22±2.27)(t=4.80, P < 0.05); in the executive function test, the results of SCWT, ROCFT, and TMT tests were significantly worse in boys with ADHD than in normal boys (t=-4.53-4.42, P < 0.05). Correlation analysis showed that the fine motor skill scores of boys with ADHD were negatively correlated with the number of word sense errors (r=-0.35) and color errors (r=-0.42), and positively correlated with memory scores for delayed structure (r=0.30) and detail (r=0.25), which were negatively correlated with TMT-A (r=-0.34), TMT-B reaction time (r=-0.26), number of errors (r=-0.43) (P < 0.05). Stratified regression analysis showed that fine motor skill scores of boys with ADHD were predictive of test results for inhibitory control, working memory and cognitive flexibility, with explanatory rates of 15%, 7%, and 19%, respectively. Conclusion Fine motor skills in boys with ADHD are correlated with executive functions, and fine motor skills could predict inhibitory control, working memory and cognitive flexibility to some extent. The development of fine motor skills in boy with ADHD could promote their executive functions.
- Attention deficit disorder with hyperactivity /
- Mental health /
- Executive function /
- Child /
- Male
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 ADHD组与正常组男童的精细动作技能和执行功能比较(x±s)

Table 1. Comparison of fine motor skills and executive functions in boys with ADHD group and normal boys group(x±s)

组别	人数	精细动作技能得分	SCWT				ROCFT				TMT
组别	人数	精细动作技能得分	字义反应时/s	字义错误数	颜色反应时/s	颜色错误数	即时结构/分	即时细节/分	延时结构/分	延时细节/分	TMT-A反应时/s	TMT-A错误数	TMT-B反应时/s	TMT-B错误数
正常组	65	11.22±2.27	22.64±8.19	0.15±0.48	45.40±13.42	1.08±1.52	3.69±1.74	13.05±6.15	3.68±1.81	12.61±6.41	52.68±21.91	0.03±0.17	155.87±73.16	0.72±1.15
ADHD组	65	8.68±3.62	32.81±16.15	0.80±1.63	56.99±16.53	2.37±3.11	2.40±1.85	8.38±5.93	2.29±1.83	7.82±6.19	64.23±32.22	0.20±0.57	194.46±85.05	2.25±2.82
t值		4.80	-4.53	-3.07	-4.39	-3.01	4.10	4.42	4.34	4.33	-2.84	-2.31	-2.77	-4.03
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	0.02	0.02	0.01	< 0.01

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表 2 ADHD男童精细动作技能与执行功能的分层线性回归分析(n=65)

Table 2. Hierarchical regression liner analysis of fine motor skills and executive function in boys with ADHD(n=65)

因变量	自变量	β值	B值	标准误	t值	R²值	调整R²值	R²变化
抑制控制	年龄	-0.32	-0.86	0.31	-2.74^**	0.27	0.23	0.15^**
	ADHD亚型	-0.04	-1.34	0.41	-0.33
	精细动作技能得分	-0.39	-0.33	0.10	-3.52^**
工作记忆	年龄	0.43	0.68	0.19	3.68^**	0.27	0.23	0.07^*
	ADHD亚型	0.02	0.04	0.24	0.18
	精细动作技能得分	0.26	0.13	0.06	2.39^*
认知灵活性	年龄	-0.18	-0.43	0.29	-1.48	0.24	0.21	0.19^**
	ADHD亚型	0.05	0.17	0.37	0.45
	精细动作技能得分	-0.44	-0.34	0.09	-3.91^**
注： P < 0.05，*P < 0.01。

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参考文献(40)

[1]	李世明, 冯为, 方芳, 等. 中国儿童注意缺陷多动障碍患病率Meta分析[J]. 中华流行病学杂志, 2018, 39(7): 993-998. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC201712017.htm LI S M, FENG W, FANG F, et al. Meta-analysis of the prevalence of attention deficit hyperactivity disorder in Chinese children[J]. Chin J Epidemiol, 2018, 39(7): 993-998. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC201712017.htm
[2]	PFIFFNER L J, ROONEY M E, JIANG Y, et al. Sustained effects of collaborative school-home intervention for attention-deficit/hyperactivity disorder symptoms and impairment[J]. J Am Acad Child Adolesc Psychiatry, 2018, 57(4): 245-251. doi: 10.1016/j.jaac.2018.01.016
[3]	杨斌让, 陈俏如. 注意缺陷多动障碍儿童执行功能的评估与干预[J]. 中国儿童保健杂志, 2022, 30(12): 1277-1281. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202212001.htm YANG B R, CHEN Q R. Assessment and intervention of executive functioning in children with attention deficit hyperactivity disorder[J]. Chin J Child Health Care, 2022, 30(12): 1277-1281. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202212001.htm
[4]	VELOSO A S, VICENTE S G, FILIPE M G. Assessment of 'Cool' and 'Hot' executive skills in children with ADHD: the role of performance measures and behavioral ratings[J]. Eur J Investig Health Psychol Educ, 2022, 12(11): 1657-1672.
[5]	NEJATI V, DERAKHSHAN Z, MOHTASHAM A. The effect of comprehensive working memory training on executive functions and behavioral symptoms in children with attention deficit-hyperactivity disorder (ADHD)[J]. Asian J Psychiatr, 2023, 81: 103469. doi: 10.1016/j.ajp.2023.103469
[6]	KAISER M L, SCHOEMAKER M M, ALBARET J M, et al. What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature[J]. Res Dev Disabil, 2015, 36(9): 338-357.
[7]	朱笑彤, 任园春, 刘靖, 等. 注意缺陷多动障碍小学生精细动作发展特点研究[J]. 中国儿童保健杂志, 2023, 31(3): 322-326. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202303018.htm ZHU X T, REN Y C, LIU J, et al. Study on the characteristics of fine motor development of elementary school students with attention deficit hyperactivity disorder[J]. Chin J Child Health Care, 2023, 31(3): 322-326. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202303018.htm
[8]	COGHILL D, HODGKINS P. Health-related quality of life of children with attention-deficit/hyperactivity disorder versus children with diabetes and healthy controls[J]. Eur Child Adolesc Psychiatry, 2016, 25(3): 261-271. doi: 10.1007/s00787-015-0728-y
[9]	BUNGER A, URFER-MAURER N, GROB A. Multimethod assessment of attention, executive functions, and motor skills in children with and without adhd: children's performance and parents' perceptions[J]. J Attent Disord, 2021, 25(4): 596-606. doi: 10.1177/1087054718824985
[10]	LIVESEY D, LUM M M, TOSHACK T, et al. The relationship between motor performance and peer relations in 9-to 12-year-old children[J]. Child Care Health Dev, 2011, 37(4): 581-588. doi: 10.1111/j.1365-2214.2010.01183.x
[11]	VON HOFSTEN C. Action, the foundation for cognitive development[J]. Scand J Psychol, 2009, 50(6): 617-623. doi: 10.1111/j.1467-9450.2009.00780.x
[12]	DIAMOND A. Close interrelation of motor development and cognitive development and of the cerebellum and prefrontal cortex[J]. Child Develop, 2000, 71(1): 44-56. doi: 10.1111/1467-8624.00117
[13]	RIDLER K, VEIJOLA J M, TANSKANEN P, et al. Fronto-cerebellar systems are associated with infant motor and adult executive functions in healthy adults but not in schizophrenia[J]. Proc Natl Acad Sci USA, 2006, 103(42): 15651-15656. doi: 10.1073/pnas.0602639103
[14]	WAGNER G, KOCH K, REICHENBACH J R, et al. The special involvement of the rostrolateral prefrontal cortex in planning abilities: an event-related fMRI study with the tower of London paradigm[J]. Neuropsychologia, 2006, 44(12): 2337-2347. doi: 10.1016/j.neuropsychologia.2006.05.014
[15]	LIVESEY D, KEEN J, ROUSE J, et al. The relationship between measures of executive function, motor performance and externalising behaviour in 5 and 6-year-old children[J]. Hum Mov Sci, 2006, 25(1): 50-64. doi: 10.1016/j.humov.2005.10.008
[16]	李斐, 颜崇淮, 沈晓明. 早期精细动作技能发育促进脑认知发展的研究进展[J]. 中华医学杂志, 2005, 85(30): 2157-2159. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYX200530024.htm LI F, YAN C H, SHEN X M. Advances in early fine motor skill development for brain cognitive development[J]. Natl Med J Chin, 2005, 85(30): 2157-2159. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYX200530024.htm
[17]	耿达, 张兴利, 施建农. 儿童早期精细动作技能与认知发展的关系[J]. 心理科学进展, 2015, 23(2): 261-267. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXD201502012.htm GWNG D, ZHANG X L, SHI J N. The relationship between fine motor skills and cognitive development in early childhood[J]. Adv Psychol Sci, 2015, 23(2): 261-267. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XLXD201502012.htm
[18]	KLUPP S, MOHRING W, LEMOLA S, et al. Relations between fine motor skills and intelligence in typically developing children and children with attention deficit hyperactivity disorder[J]. Res Dev Disabil, 2021, 110: 103855. doi: 10.1016/j.ridd.2021.103855
[19]	ZIEREIS S, JANSEN P. Correlation of motor abilities and executive functions in children with ADHD[J]. Appl Neuropsychol Child, 2016, 5(2): 138-148. doi: 10.1080/21622965.2015.1038746
[20]	CAK H T, KARAOKUR R, ATASAVUN U S, et al. Motor proficiency in children with attention deficit hyperactivity disorder: associations with cognitive skills and symptom severity[J]. Turk Psikiyatr Derg, 2018, 29(2): 92-101.
[21]	范娟, 杜亚松, 王立伟. Conners父母用症状问卷的中国城市常模和信度研究[J]. 上海精神医学, 2005, 17(6): 321-323. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI200506001.htm FAN J, DU Y S, WANG L W. A study of the normality and reliability of the Conners Parental Symptom Questionnaire in urban China[J]. Shanghai Archiv Psy, 2005, 17(6): 321-323. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI200506001.htm
[22]	苏林雁, 耿耀国, 王洪, 等. 注意缺陷多动障碍诊断量表父母版的中国城市儿童常模制定及其信度和效度的检验[J]. 中国实用儿科杂志, 2006, 21(11): 833-836. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK200611015.htm SU L Y, GENG Y G, WANG H, et al. Development of the parent version of the attention deficit hyperactivity disorder (ADHD) diagnostic scale for Chinese urban children and its reliability and validity tests[J]. Chin J Pract Pediatr, 2006, 21(11): 833-836. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK200611015.htm
[23]	刘豫鑫, 刘津, 王玉凤. 简明儿童少年国际神经精神访谈儿童版的信效度[J]. 中国心理卫生杂志, 2011, 25(1): 8-13. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201101002.htm LIU Y L, LIU J, WANG Y F. Reliability and validity of the child version of the Brief Child and Adolescent International Neuropsychiatric Interview[J]. Chin Ment Health J, 2011, 25(1): 8-13. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201101002.htm
[24]	KAUFMAN J, BIRMAHER B, BRENT D, et al. Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data[J]. J Am Acad Child Adolesc Psychiatry, 1997, 36(7): 980-988.
[25]	张厚粲. 韦氏儿童智力量表第四版(WISC-Ⅳ)中文版的修订[J]. 心理科学, 2009, 32(5): 1177-1179. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX200905046.htm ZHANG H C. Revision of the Chinese version of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-Ⅳ)[J]. Psych Sci, 2009, 32(5): 1177-1179. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX200905046.htm
[26]	ASSOCIATION A P. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-V)[M]. Washington: American Psychiatric Publishing, 2013: 61.
[27]	SCHULZ J, HENDERSON S E, SUGDEN D A, et al. Structural validity of the movement ABC-2 test: factor structure comparisons across three age groups[J]. Res Dev Disabil, 2011, 32(4): 1361-1369.
[28]	花静, 吴擢春, 孟炜, 等. 儿童发育协调障碍评估工具在我国应用效度的初步分析[J]. 中国儿童保健杂志, 2010, 18(7): 556-559. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201007010.htm HUA J, WU Z C, MENG W, et al. A preliminary analysis of the validity of the assessment tool for developmental coordination disorder in children in China[J]. Chin J Child Health Care, 2010, 18(7): 556-559. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201007010.htm
[29]	SCARPINA F, TAGINI S. The Stroop Color and Word Test[J]. Front Psychol, 2017, 8: 557.
[30]	周新祥, 龚文苹, 裘林秋, 等. Rey-Osterrich复杂图形测验在非痴呆型血管性认知损害患者中的应用[J]. 心脑血管病防治, 2015, 15(4): 305-306. https://www.cnki.com.cn/Article/CJFDTOTAL-XXFZ201504014.htm ZHOU X X, GONG W P, QIU L Q, et al. The Rey-Osterrich complex figure test in patients with nondemented vascular cognitive impairment[J]. Prev Treat Cardio-Cerebral-Vascul Dis, 2015, 15(4): 305-306. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XXFZ201504014.htm
[31]	翟倩, 丰雷, 张国富. 精神分裂症患者的执行功能障碍研究[J]. 中国全科医学, 2020, 23(14): 1785-1789. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202014014.htm ZHAI Q, FENG L, ZHANG G F. Executive dysfunction in schizophrenics[J]. Chin Gen Prac, 2020, 23(14): 1785-1789. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202014014.htm
[32]	HANAKAWA T. Rostral premotor cortex as a gateway between motor and cognitive networks[J]. Neurosci Res, 2011, 70(2): 144-154.
[33]	ZWICKER J G, MISSIUNA C, HARRIS S R, et al. Brain activation associated with motor skill practice in children with developmental coordination disorder: an fMRI study[J]. Inter J Develop Neurosci, 2011, 29(2): 145-152.
[34]	STUHR C, HUGHES C, STOCKEL T. The role of executive functions for motor performance in preschool children as compared to young adults[J]. Front Psychol, 2020, 11(1): 1552.
[35]	MIDDLETON F A, STRICK P L. Basal ganglia and cerebellar loops: motor and cognitive circuits[J]. Brain Res Brain Res Rev, 2000, 31(2-3): 236-250.
[36]	SCHWARZ C, THIER P. Binding of signals relevant for action: towards a hypothesis of the functional role of the pontine nuclei[J]. Trends Neurosci, 1999, 22(10): 443-451.
[37]	BERQUIN P C, GIEDD J N, JACOBSEN L K, et al. Morphometric MRI study Cerebellum in attention-deficit hyperactivity disorder: a Morphometric MRI study[J]. Neurology, 1998, 50(4): 1087-1093.
[38]	HOUWEN S, VAN DER VEER G, VISSER J, et al. The relationship between motor performance and parent-rated executive functioning in 3-to 5-year-old children: what is the role of confounding variables?[J]. Hum Mov Sci, 2017, 53: 24-36.
[39]	BURNS Y, O'CALLAGHAN M, MCDONELL B, et al. Movement and motor development in ELBW infants at 1 year is related to cognitive and motor abilities at 4 years[J]. Early Hum Dev, 2004, 80(1): 19-29.
[40]	DAHAN A, RYDER C H, REINER M. Components of motor deficiencies in ADHD and possible interventions[J]. Neuroscience, 2018, 378: 34-53.