目的 分析综合干预治疗和单纯药物治疗对注意缺陷多动障碍(ADHD)患儿症状及执行功能缺陷的改善情况,为ADHD诊疗参考。方法 将上海市精神卫生中心2018年1月-2019年2月儿少科门诊就诊的61例ADHD患儿随机分为综合干预组与药物治疗组,评估其症状及执行功能指标的变化。结果 1)综合干预组治疗后SNAP-Ⅳ评分中注意缺陷、多动、对立性因子均低于治疗前,差异均有统计学意义(t=7.339、5.637、7.211,P<0.001);Stroop测试乙表正确率高于治疗前,差异有统计学意义(t=-3.036,P<0.001);WCST持续错误数低于治疗前,分类完成数、概念化水平、持续应答数均高于治疗前,差异均有统计学意义(t=5.961、-2.465、-5.585、-3.524,P<0.05)。2)治疗后综合干预组SNAP-Ⅳ评分中注意缺陷、多动、对立性因子均明显低于药物治疗组,差异有统计学意义(F=8.270、6.818、10.786,P<0.05或<0.001);Stroop色-词测试甲表正确率高于药物治疗组,差异有统计学意义(F=11.125,P=0.001);WCST持续错误数明显低于药物治疗组,概念化水平、持续应答数明显高于药物治疗组,差异有统计学意义(F=5.567、5.775、4.436,P<0.05)。结论 综合干预治疗可以改善ADHD患儿的核心症状和执行功能缺陷,是治疗ADHD的优化治疗选择。
Abstract
Objective To explore the improvement of symptoms and executive dysfunction in children with attention deficit hyperactivity disorder (ADHD) by multimodal therapy and medication alone,so as to provide evidence reference for the treatment of ADHD. Methods A total of 61 children with ADHD from Shanghai Mental Health Center were enrolled in this study from January 2018 to February 2019,and were randomly divided into multimodal group and medication group.The changes of symptoms and executive function were evaluated. Results 1) After treatment,scores of attention deficit,hyperkinetic and oppositional factor in SNAP-IV in the multimodal intervention group were significantly lower than those before treatment (t=7.339,5.637,7.211,P<0.001).The accuracy of Stroop Test B after treatment was significantly higher than that before treatment (t=-3.036,P<0.001).And the number of persistent errors (t=5.961,P<0.001) was lower than that before treatment.The scores of classification,conceptualization and sustained response were significantly higher than those before and after treatment (t=-2.465,-5.585,-3.524,P<0.05).2) After treatment,attention deficit,hyperkinetic,and oppositional factors in SNAP-IV in multimodal therapy group were significantly lower than those in drug treatment group (F=8.270,6.818,10.786, P<0.05).There were significant differences on Stroop color-word Test A between the two groups (F=11.125,P=0.001).And the sustained errors of WCST were significantly lower in the Stroop test group than in the drug treatment group (F=5.567,P<0.05).The level of conceptualization and the number of sustained response were significantly higher than those in the drug treatment group (F=5.775,4.436,P<0.05). Conclusionss Multimodal therapy can improve the core symptoms and executive dysfunction of ADHD children,which can be the priority for ADHD treatment.
关键词
注意缺陷多动障碍 /
综合干预治疗 /
亲子团体治疗 /
神经发育障碍
Key words
attention deficit hyperactivity disorder /
multimodal therapy /
parent-child group therapy
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基金
重大慢性非传染性疾病防控研究(2016YFC1306102);上海市卫计委课题(201640286);国家自然科学基金面上项目(81771477);上海市卫生计生委智慧医疗专项研究项目(2018ZHYL0210);上海市精神卫生中心院级课题(2018-YJ-14)
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