目的 分析执行功能是否能够在儿童语言障碍与多动/注意缺陷行为问题的相互关系中起到显著的调节作用,为儿童语言障碍和多动/注意缺陷障碍共病的诊治提供依据。方法 收集2014年9-11月上海儿童医学中心确诊的语言障碍儿童19例(男∶女为12∶7),平均年龄(57.5±11.8)个月,选同期门诊健康体检的语言正常儿童41例(男∶女为29∶12),平均年龄(63.0±15.9)个月,采用年龄和性别1∶2配对病例对照研究,回顾性收集两组儿童的语言、执行功能、长处与困难问卷SDQ、非语言智力等资料。分析两组儿童神经认知功能的差异和多动/注意缺陷行为的差异。使用Bootstrapping分析短时记忆与抑制功能是否在语言障碍影响多动/注意缺陷行为发生的关系中存在显著的中介作用。结果 语言障碍组儿童短时记忆与抑制控制均显著低于非语言障碍组儿童(t=3.72、3.30,P<0.01,效应值为0.96、0.82),SDQ多动/注意缺陷得分均显著高于正常组儿童(t=-2.24,P=0.029,效应值0.65)。短时记忆和抑制控制未产生显著的共同中介效应。探讨独立中介效应时,短时记忆与抑制功能均产生显著的中介作用,非语言智力不能影响这一过程。结论 语言障碍儿童短时记忆与抑制控制均能够独立作为中介因素,影响语言障碍儿童产生多动/注意缺陷行为。但短时记忆与抑制控制不能够共同调节这一效应。
Abstract
Objective To investigate whether executive function can mediate the effect of language impairments on hyperactivity/inattention symptoms or not,in order to provide evidence for diagnose and treatment of comorbidity of language impairment with attention deficit/hyperactivity disorder in children.Methods The clinical data were retrospectively analyzed in 19 language impairment children(boys∶girls=12∶7),with average age of(57.5±11.8) months from September to November in 2014. Meanwhile 41 healthy children with normal language development(boys∶girls=29∶12) were selected as control group,with average age of(63.0±15.9) months. A case-control study was performed between two groups 1∶2 matched by age and sex. All data on language,executive functions,the Strengths and Difficulties Questionnaire(SDQ) and nonverbal intelligence quotient were collected. t-test was used to test the group differences on short-term memory(STM),inhibitory control and the SDQ hyperactivity/inattention scores. Bootstrapping was used to identify mediation effect of executive functions on the relationship between language impairment and hyperactivity/inattention symptoms. Results Children with language impairment had significantly poorer STM and inhibitory control functions(t=3.72,3.30, P＜0.01,Cohen′s d=0.96,0.82) than normal children. Moreover,children with language impairment scored significantly higher on the hyperactivity/inattention than normal children(t=-2.24,P=0.029,Cohen′s d =0.65). Bootstrapping results showed that short-term memory and inhibitory control had no evident mutual impact on language impairment′s effect for hyperactivity/inattention,but mediating effect of short-term memory and inhibitory control remained significant when testing independent mediating effect separately. And nonverbal IQ did not influence these results. Conclusion Language impairment′s influence for hyperactivity/inattention symptoms can be independently mediated by short-term memory and inhibitory control respectively.
关键词
语言障碍 /
多动/注意缺陷 /
执行功能 /
短时记忆 /
抑制控制
Key words
language impairment /
hyperactivity/inattention /
executive function /
short-term memory /
inhibitory control
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基金
上海市科学技术委员会科研计划项目(14441904003)
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