注意缺陷多动障碍儿童执行功能的评估与干预

杨斌让; 陈俏如

doi:10.11852/zgetbjzz2022-1315

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中国儿童保健杂志 ›› 2022, Vol. 30 ›› Issue (12) : 1277-1281. DOI: 10.11852/zgetbjzz2022-1315

专家笔谈

注意缺陷多动障碍儿童执行功能的评估与干预

杨斌让, 陈俏如

作者信息 +

Evaluation and intervention of hot- and cool-executive function in children with attention deficit hyperactivity disorder

YANG Bin-rang, CHEN Qiao-ru

Author information +

文章历史 +

摘要

ADHD儿童认知障碍的主要特征之一是执行功能损害,涉及包括前额叶皮层在内的特定脑区域及多层级脑网络异常。执行功能按照功能性分为冷-热两方面:冷执行功能损害主要表现于反应抑制、工作记忆以及认知灵活性等;热执行功能损害通常涉及延迟满足、赏罚相关决策、自我调节及情绪调节等。ADHD儿童的执行功能评估应基于可信范式进行文化适应性调整。临床干预不能单一聚焦于冷执行功能,需关注儿童的身体发育以及热执行功能(情绪社会方面)的发展进程,结合其他共病与心理状况,进行全面的动态随访与干预,以达到最佳的长期疗效。

Abstract

Executive function impairment emerges as a primary cognitive deficit in children with attention deficit hyperactivity disorder (ADHD), involving prefrontal cortex and multi-level brain network dysfunction. Executive function has been functionally classified into cool and hot. Cool-executive function impairment mainly manifests in response inhibition, working memory and cognitive flexibility, while hot-executive function impairment usually involves delayed gratification, reward/punishment-related decision-making, self-regulation and emotion regulation. A variety of traditional paradigms have been used when assessing executive function in ADHD children, some of which are reliably modified and culturally adapted. Based on the literature, clinical practice should not focus exclusively on cool executive function. Children′s impairment in hot executive function (with emotional and social components) should also be noted as significant indicators when evaluating the state of children′s condition. Additionally, dynamic follow-up and intervention should be required to achieve the best results in the long term.

导出引用

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://doi.org/10.11852/zgetbjzz2022-1315

YANG Bin-rang, CHEN Qiao-ru. Evaluation and intervention of hot- and cool-executive function in children with attention deficit hyperactivity disorder[J]. Chinese Journal of Child Health Care. 2022, 30(12): 1277-1281 https://doi.org/10.11852/zgetbjzz2022-1315

中图分类号： R749.94

参考文献

[1] MTA Cooperative Group, Multimodal Treatment Study ofChildren with ADHD:A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder [J]. Arch Gen Psychiatry, 1999(56):1073-1086.
[2] Sibley MH, Arnold LE, Swanson JM, et al. Variable patterns of remission from ADHD in the multimodal treatment study of ADHD[J]. Am J Psychiat, 2022, 179(2):142-151.
[3] Nigg JT. Annual research review:On the relations among self-regulation, self-control, executive functioning, effortful control, cognitive control, impulsivity, risk-taking, and inhibition for developmental psychopathology [J]. J Child Psychol Psyc, 2017, 58(4):361-383.
[4] Zelazo PD, Carlson SM, Kesek A. The development of executive function in childhood[M]// Nelson CA,Luciana M. Handbook of developmental cognitive neuroscience. Cambridge:MIT Press,2008:553-574.
[5] Sonuga-Barke EJ.The dual pathway model of AD/HD:An elaboration of neuro-developmental characteristics [J]. Neurosci Biobehav R, 2003, 27(7):593-604.
[6] Brown T.Attention deficit disorder:The unfocused mind in children andadults[M]. New Haven:Yale University Press, 2006.
[7] Barkley RA, Murphy KR, Fischer M.ADHD in adults:What the sciencesays[M]. New York:Guilford Press,2010.
[8] Barkley RA. What is executive function? 7 deficits tied to ADHD[EB/OL].(2022-11-02) https://www.additudemag.com/7-executive-function-deficits-linked-to-adhd/.
[9] Diamond A, Lee K.Interventions shown to aid executive function development in children 4 to 12 years old [J]. Science,2011, 333(6045):959-964.
[10] Barkley RA. Executive functions:What they are, how they work,and why they evolved[M]. New York:Guilford Press,2020.
[11] Salehinejad MA, Ghanavati E, et al. Hot and cold executive functions in the brain:A prefrontal-cingular network [J]. Brain Neurosci Adv, 2021, 5:23982128211007769.
[12] Faraone SV, Asherson P, Banaschewski T, et al. Attention-deficit/hyperactivity disorder[J]. Nat Rev Dis Primers, 2015, 1:15020.
[13] Tang C, Wei Y, Zhao J, et al. Different developmental pattern of brain activities in ADHD:A study of resting-state fMRI [J].Dev Neurosci, 2018, 40(3):246-257.
[14] Zelazo PD. Executive function and psychopathology:A neurodevelopmental perspective[J]. Annu Rev Clin Psychol,2020, 16(1):431-454.
[15] Willcutt EG, Doyle AE, Nigg JT, et al. Validity of the executive function theory of attention-deficit/hyperactivity disorder:A meta-analytic review [J]. Biol Psychiat, 2005, 57(11):1336-1346.
[16] Willoughby M,Kupersmidt J, Voegler-Lee M, et al. Contributions of hot and cool self-regulation to preschool disruptive behavior and academic achievement [J]. Dev Neuropsychol, 2011, 36(2):162-180.
[17] Repovs G, Baddeley A.The multi-component model of working memory:Explorations in experimental cognitive psycholody [J].Neurosci, 2006(139):5-21.
[18] Mehsen V, Morag L, Chesta S, et al. Hot executive function assessment instruments in preschool children:A systematic review [J]. Int J Environ Res Public Health, 2021, 19(1):95.
[19] Marco R, Miranda A,Schlotz W, et al. Delay and reward choice in ADHD:An experimental test of the role of delay aversion [J]. Neuropsychology, 2009, 23(3):367.
[20] Kable JW, Glimcher PW. The neurobiology of decision:Consensus and controversy [J]. Neuron, 2009, 63(6):733-745.
[21] vanMeel CS, Heslenfeld DJ, Oosterlaan J, et al. ERPs associated with monitoring and evaluation of monetary reward and punishment in children with ADHD [J]. J Child Psychol Psyc, 2011, 52(9):942-953.
[22] Russo SJ,Nestler EJ. The brain reward circuitry in mood disorders [J]. Nat Rev Neurosci, 2013, 14(9):609-625.
[23] Schönenberg M, Schneidt A, Wiedemann E, et al. Processing of dynamic affective information in adults with ADHD [J]. J Atten Disord, 2009, 23(1):32-39.
[24] Faraone SV.The pharmacology of amphetamine and methylphenidate:Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities [J]. Neurosci Biobehav Rev, 2018, 87:255-270.
[25] Costa A, Riedel M,Pogarell O, et al. Methylphenidate effects on neural activity during response inhibition in healthy humans [J]. Cereb Cortex, 2013, 23(5):1179-1189.
[26] Moeller SJ,Honorio J, Tomasi D, et al. Methylphenidate enhances executive function and optimizes prefrontal function in both health and cocaine addiction [J]. Cereb Cortex, 2014, 24(3):643-653.
[27] de Jong CG, van DeVoorde S, Roeyers H, et al. Differential effects of atomoxetine on executive functioning and lexical decision in attention-deficit/hyperactivity disorder and reading disorder [J]. J Child Adol Psychop, 2009, 19(6):699-707.
[28] Brown TE,Holdnack J, Saylor K, et al. Effect of atomoxetine on executive function impairments in adults with ADHD [J]. J Atten Disord, 2011,15(2):130-138.
[29] Chen S, Yu J, Zhang Q, et al. Which factor is more relevant to the effectiveness of the cognitive intervention?A meta-analysis of randomized controlled trials of cognitive training on symptoms and executive function behaviors of children with ADHD [J]. Front Psychol, 2022, 12:810298.
[30] Cortese S, Ferrin M, Brandeis D, et al. Cognitive training for attention-deficit/hyperactivity disorder:Meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials [J]. J Am Acad Child Psy, 2015, 54(3):164-174.