目的 分析不同注意力、控制力水平注意缺陷多动障碍(ADHD)儿童认知功能的特点以及与认知功能的关系。方法 选取2022年1月-2023年4月于首都儿科研究所附属儿童医院神经内科门诊和多动症门诊就诊的ADHD儿童共104例,进行韦氏、视听整合持续操作测验(IVA-CPT)及认知功能测试。依据IVA-CPT结果,将ADHD儿童分为注意缺陷型(ADHD-I)、多动冲动型(ADHD-HI)及混合型(ADHD-C)。采用SPSS 23.0比较三种亚型ADHD儿童认知功能特点,并分析认知功能与症状评分、注意力、控制力的相关性。结果 三组患儿智商、数学认知能力、数字推理能力、序列关系、短时记忆广度(倒叙)差异有统计学意义(P＜0.05);两两比较,ADHD-HI型儿童的智商、数学认知能力、数字推理能力、序列关系均优于ADHD-C型及ADHD-I型(P＜0.05)。ADHD儿童的认知能力与智商呈正相关(r=0.332~0.399,P＜0.05)。在认知功能与IVA成绩的相关性分析中,ADHD儿童的序列关系和比较大小测试成绩与IVA-CPT结果呈低度正相关(r=0.300~0.337,P＜0.05),而认知功能与SNAP-Ⅳ症状评分的相关性分析中,未出现明显的相关性(r＜0.3)。结论 注意力水平较低的ADHD儿童其认知功能较差;注意力与序列关系、比较大小测试成绩具有一定的相关性。
Abstract
Objective To analyze the characteristics of cognitive function in children with attention-deficit/hyperactivity disorder (ADHD) at different levels of attention and control,as well as their relationship with cognitive function. Methods A total of 104 children with ADHD who visited the Outpatient Department of Neurology and ADHD Clinic of the Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2022 to April 2023 were selected into this study to perform Wechwecht test,Integrated Visual and Auditory Continuous Performance Test (IVA-CPT),and cognitive function tests.According to the results ofIVA-CPT, children with ADHD were divided into attention deficit type (ADHD-I),hyperactive and impulsive type (ADHD-HI) and combined type (ADHD-C).SPSS 23.0 statistical software package was used to compare the cognitive function characteristics of the three subtypes of ADHD children,and the correlation of cognitive function with symptom scores,attention and control was analyzed. Results There were significant differences in intelligence quotient (IQ),mathematical cognitive ability,numerical reasoning ability,sequential relationship and short-term memory span (flashback) among the three groups(P＜0.05).In pairwise comparisons,children with ADHD-HI showed superior IQ,mathematical cognitive abilities,numerical reasoning abilities,and sequential relationships compared to children with ADHD-C and ADHD-I (P<0.05).The cognitive ability of ADHD children was positively correlated with IQ (r=0.332 - 0.399,P＜0.05).In the correlation analysis between cognitive function and IVA scores,sequential relationships and comparison performance were slightly positively correlated with IVA-CPT results in children with ADHD (r=0.300 - 0.337,P<0.05).However,no significant correlation was found between cognitive function and SNAP-Ⅳ symptom scores (r<0.3). Conclusions ADHD children with low attention level have poor cognitive functions.Attention is correlation with sequential relation and comparison size test scores.
关键词
注意缺陷多动障碍 /
认知功能 /
儿童 /
注意力 /
抑制控制
Key words
attention-deficit/hyperactivity disorder /
cognitive function /
children /
attention /
inhibitory control
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Li FH,Cui YH,Li Y,et al.Prevalence of mental disorders in school children and adolescents in China:Diagnostic data from detailed clinical assessments of 17,524 individuals[J].J Child Psychol Psychiatry,2022,63(1):34-46.
[2] Posner J,Polanczyk GV,Sonuga-barke E.Attention-deficit hyperactivity disorder[J].Lancet,2020,395(10222):450-462.
[3] Barkley RA.Advancing age,declining ADHD[J].Am J Psychiatry,1997,154(9):1323-1325.
[4] Pereira-sanchez V,Castellanos FX.Neuroimaging in attention-deficit/hyperactivity disorder[J].Curr Opin Psychiatry,2021,34(2):105-111.
[5] Barkley RA.Attention-deficit/hyperactivity disorder,self-regulation,and time:Toward a more comprehensive theory[J].J Dev Behav Pediatr,1997,18(4):271-279.
[6] Barkley RA.Behavioral inhibition,sustained attention,and executive functions:Constructing a unifying theory of ADHD[J].Psychol Bull,1997,121(1):65-94.
[7] Kofler MJ,Irwin LN,Soto EF,et al.Executive functioning heterogeneity in pediatric ADHD[J].J Abnorm Child Psychol,2019,47(2):273-286.
[8] 刘思奇,朱一可,张樊,等.不同亚型注意缺陷多动障碍儿童认知功能特点的比较[J].中华行为医学与脑科学杂志,2021,30(10):910-915.
Liu SQ,Zhu YK,Zhang F,et al.Comparison of cognitive function in children with different subtypes of attention deficit hyperactivity disorder[J].Chin J Behav Med Brain Sci,2021,30(10):910-915.(in Chinese)
[9] American Psychiatric Association.Diagnostic and statistical manual of mental disorders[M].5th ed.Washington DC:American Psychiatric Publishing,2013.
[10] 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.
Zhou JB,Guo LT,Chen Y.Reliability and validity of the Chinese version of Swanson,Nolan,and Pelham Version IV Rating Scale-Parent Form for attention-deficit/hyperactivity disorder[J].Chin J Ment N.A,2013,27(6):424-428.(in Chinese)
[11] 龚耀先,蔡太生,周世杰,等.韦氏儿童智力量表在中国的修订及应用[J].医学研究通讯,1999(2):14-15.
Gong YX,Cai TS,Zhou SJ,et al.The revision and application of Wechsler Intelligence scale for children in China[J].Chin J Med Res,1999(2):14-15.(in Chinese)
[12] 潘学霞,麻宏伟,戴晓梅.整合视听连续测试诊断注意缺陷多动障碍的临床应用探讨[J].中国当代儿科杂志,2007,(3):210-212.
Pan XX,Ma HW,Dai XM.Value of integrated visual and auditory continuous performance test in the diagnosis of childhood attention deficit hyperactivity disorder[J].Chin J Contemp Pediat,2007,9(3):210-212.(in Chinese)
[13] Lin IC,Chang SC,Huang YJ,et al.Distinguishing different types of attention deficit hyperactivity disorder in children using artificial neural network with clinical intelligent test[J].Front Psychol,2022,13:1067771.
[14] Wei W,Lu H,Zhao H,et al.Gender differences in children's arithmetic performance are accounted for by gender differences in language abilities[J].Psychol Sci,2012,23(3):320-330.
[15] Çak HT,Çengel KSE,Gökler B,et al.The Behavior Rating Inventory of Executive Function and Continuous Performance Test in preschoolers with attention deficit hyperactivity disorder[J].Psychiatry Investig,2017,14(3):260-270.
[16] Faedda N,Romani M,Rossetti S,et al.Intellectual functioning and executive functions in children and adolescents with attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD)[J].Scand J Psychol,2019,60(5):440-446.
[17] Soares PSM,De Oliveira PD,Wehrmeister FC,et al.Does IQ influence association between working memory and ADHD symptoms in young adults?[J].J Atten Disord,2022,26(8):1097-1105.
[18] Cadenas M,Hartman C,Faraone S,et al.Cognitive correlates of attention-deficit hyperactivity disorder in children and adolescents with high intellectual ability[J].J Neurodev Disord,2020,12(1):6.
[19] Agnew-blais JC,Polanczyk GV,Danese A,et al.Are changes in ADHD course reflected in differences in IQ and executive functioning from childhood to young adulthood?[J].Psychol Med,2020,50(16):2799-2808.
[20] Friedman LM,Rapport MD,Orban SA,et al.Applied problem solving in children with ADHD:The mediating roles of working memory and mathematical calculation[J].J Abnorm Child Psychol,2018,46(3):491-504.
[21] Ganor-stern D,Steinhorn O.ADHD and math-The differential effect on calculation and estimation[J].Acta Psychol (Amst),2018,188:55-64.
[22] Mano QR,Jastrowski MKE,Guerin JM,et al.Fluid reasoning and reading difficulties among children with ADHD[J].Appl Neuropsychol Child,2019,8(4):307-318.
[23] Westwood SJ,Parlatini V,Rubia K,et al.Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD):A meta-analysis of randomized controlled trials with blinded and objective outcomes[J].Mol Psychiatry,2023,28(4):1402-1414.
[24] Wells EL,Kofler MJ,Soto EF,et al.Assessing working memory in children with ADHD:Minor administration and scoring changes may improve digit span backward's construct validity[J].Res Dev Disabil,2018,72:166-178.
[25] Kowalczyk OS,Cubillo AI,Smith A,et al.Methylphenidate and atomoxetine normalise fronto-parietal underactivation during sustained attention in ADHD adolescents[J].Eur Neuropsychopharmacol,2019,29(10):1102-1116.
[26] D'mello AM,Gabrieli JDE.Cognitive neuroscience of dyslexia[J].Lang Speech Hear Serv Sch,2018,49(4):798-809.
[27] Mu SH,Wu HJ,Zhang J,et al.Structural brain changes and associated symptoms of ADHD subtypes in children[J].Cereb Cortex,2022,32(6):1152-1158.
[28] Krieger V,Amador-campos JA.Clinical presentations of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents:Comparison of neurocognitive performance[J].Child Neuropsychol,2021,27(8):1024-1053.
[29] Wu T,Shen HJ,Sheng YY,et al.Use of cognitive correction training improves learning for children with mathema tics learning disability[J].Appl Neuropsychol Child,2020,9(2):172-178.
基金
国家自然科学基金面上项目(82271579);首都卫生发展科研专项(首发2020-1-4111)
PDF(615 KB)
