目的 分析注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)共患对立违抗障碍(oppositional defiant disorder,ODD)患儿行为与父母间冲突的关系。方法 选择符合美国《精神障碍诊断与统计手册(第Ⅳ版)》(DSM-Ⅳ)中ADHD和诊断标准的门诊儿童,ADHD伴ODD者33例(占总数的55%)为共患组,单纯ADHD者27例(占总数的45%)为ADHD组。由儿童填写儿童对婚姻冲突的感知量表(Children's Perception of Interparental Conflict Scale,CPIC),其父母填写Achenbach儿童行为量表(Achenbach's Child Behavior Checklist,CBCL)。对数据结果进行t检验、相关分析及Logistic回归分析。结果 1)共患组在CPIC各因子及总分得分均显著高于ADHD组(P＜0.05),焦虑/抑郁问题、违纪行为、攻击行为、外化性行为问题的得分及行为问题总分显著高于ADHD组(P＜0.05);2)相关分析发现,共患组儿童社交问题、注意问题、违纪行为、攻击行为、外化性行为问题与感知到的婚姻冲突存在相关性;3)Logistic回归分析显示,保留在模型中的变量有自我归因(P=0.005,OR=1.489),应对效能(P=0.026,OR=1.329),冲突频率(P=0.019,OR=1.254)。结论 共患组儿童有更多的行为问题,可能与父母婚姻间冲突有关,儿童对婚姻冲突的感知中的自我归因、应对效能、冲突频率增加了ADHD共发ODD的危险,提示对共患有ODD、ADHD的儿童进行治疗时,不仅要注意调节其父母关系,更要引导儿童正确看待婚姻冲突。
Abstract
Objective To explore the relationship between the interparental conflict and comorbidity in children who have attention deficit hyperactivity disorder(ADHD) with oppositional defiant disorder(ODD). Methods According to DSM-Ⅳ diagnostic criteria,the study involved 33(55%) ADHD children with ODD(combined group) and 27(45%) ADHD without ODD(ADHD group).The Children's Perception of Interparental Conflict Scale (CPIC) was completed by those children.Their parents completed Achenbach's Child Behavior Checklist (CBCL).Then the data were analysed with t-test,correlation analysis and Logistic regression. Results 1)The scores of each factor and the total in CPIC of combined group were all higher than those of the ADHD group (P＜0.05).The scores of behavior problems in anxiety/depression,disobeying,attacking,extroversion and total of combined group were higher than those of the ADHD group (P＜0.05).2) Correlation analysis discovered that the social problems,attention problems,delinquent behavior,aggressive behavior and externalizing were related with interparental conflict.3)Logistic regression analysis showed that self-blame(P=0.005,OR=1.489),coping efficacy(P=0.026,OR=1.329) and conflict frequency(P=0.019,OR=1.254) were left in the model. Conclusions Children with ADHD combine ODD have more behavior problems,which are associated with interparental conflict.Self-blame,coping efficacy and conflict frequency are risk factors of ADHD comorbid with ODD.It prompts,it not only pay attention to adjusting relationship between the parents but also emphasize on how to guide the children to look reality in the inter-parental conflict in the treatment of children ADHD combine ODD.
关键词
注意缺陷多动障碍 /
对立违抗障碍 /
父母冲突 /
行为问题
Key words
attention deficit hyperactivity disorder /
oppositional defiant disorder /
interparental conflict /
behavior problem
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